摘要
（HbA1c）10.7%]的青年女性糖尿病患者,采用多种手段评价胰岛素抵抗程度和脂肪萎缩部位及程度.结果 该患者停用胰岛素后检查,发现存在明显高胰岛素血症（空腹54.7 mU/L,餐后2 h 93.9 mU/L）、重度胰岛素抵抗[葡萄糖平均输注率0.54 mg/（kg·min）,正常值（11.56±1.74）mg/（kg·min）]、重度高甘油三酯血症（14.08 mmol/L）和脂肪肝.血清脂联素水平0.12 mg/L,瘦素0.24 ng/L,均显著降低.自身免疫多项指标未见异常.磁共振成像检查显示腹腔脏器脂肪、下肢皮下脂肪萎缩.皮肤活组织病理检查显示皮下几乎未见脂肪组织.治疗中逐步增加胰岛素剂量（全天用量170 U,4.9 U/kg体重）及二甲双胍、盐酸吡格列酮剂量后,血糖控制较前好转（HbA1c 7.1%～7.8%）.结论 对于体型重度消瘦而胰岛素抵抗严重的糖尿病患者,应当注意脂肪营养不良症这一特殊类型糖尿病的筛查和正确诊治.
Objective To investigate the clinical features of idiopathic acquired generalized lipodystrophy （AGL） in one young female diabetic patient and to summarize the clinical experience in diagnosis and treatment of this disease. Methods The young female diabetic patient became thinner since childhood, however administration with overdosed insulin （4.3 U/kg body weight） could not get blood glucose well controlled [glycated hemoglobin A1c （HbA1c） 10.7%]. Several explorations were performed to evaluate the severity of her insulin resistance and lipodystrophy. Results This patient had obvious hyperinsulinemia （fasting insulin 54.7 mU/L, postprandial insulin 93.9 mU/L） and serious insulin resistance [glucose infusion rate 0.54 mg/（kg·min）, normal range （11.56±1.74） mg/（kg·min）] after insulin administration suspended, as well as serious hypertriglycemia （14.08 mmol/L） and fatty liver. Serum adiponectin and leptin were 0.12 mg/L and 0.24 ng/L respectively, both were much lower than normal level. Various indicators of autoimmune disease were negative. Magnetic resonance imaging detected atrophy of adipose tissue in abdominal viscera and lower limbs. Skin biopsy showed serious lipodystrophy. With gradually increased insulin dosage （total daily dosage 170 U, 4.9 U/kg） combined with metformin and pioglitazone, her glycemic control improved （HbA1c 7.1%-7.8%）. Conclusion For young diabetic patient with very low body weight and serious insulin resistance, the differential diagnosis of lipodystrophy, one special type of diabetes mellitus, should be paid more attention.
出处
《中华糖尿病杂志》
CAS
CSCD
2017年第6期388-392,共5页
CHINESE JOURNAL OF DIABETES MELLITUS
