随访一例因使用甲巯咪唑诱发胰岛素自身免疫综合征(IAS)的患者,分析患者临床资料及诊治过程,并对相关文献进行复习。患者服用甲巯咪唑4月后反复出现“心悸、乏力、大汗”等表现,伴有烦躁、易激动等焦虑情绪,多次就诊于我院急诊科,发作...随访一例因使用甲巯咪唑诱发胰岛素自身免疫综合征(IAS)的患者,分析患者临床资料及诊治过程,并对相关文献进行复习。患者服用甲巯咪唑4月后反复出现“心悸、乏力、大汗”等表现,伴有烦躁、易激动等焦虑情绪,多次就诊于我院急诊科,发作时血糖最低3.0 mmol/L,进食或补充葡萄糖后症状好转,持续葡萄糖监测示有反复低血糖发生。实验室检查示血清胰岛素自身抗体(IAA)阳性,确诊为IAS。入院后停用甲巯咪唑,改为丙硫氧嘧啶,调整饮食结构,予泼泥松30 mg/d,低血糖发作逐渐缓解。随访2个月,未再发生低血糖症状,血清IAA水平明显降低。IAS是发生反复低血糖的病因之一,可由服用含羟基药物诱发,以甲巯咪唑最为常见。IAA检测为诊断该病的主要依据,经治疗预后良好。A patient with methimazole-induced insulin autoimmune syndrome (IAS) was followed up with the analysis of his clinical data, diagnosis and treatment process, and a literature review was performed. After taking methimazole for 4 months, the patient repeatedly had “palpitations, fatigue, sweating”, accompanied by irritability, irritability and other anxious emotions, and visited the emergency department of our hospital many times, and the blood glucose was as low as 3.0 mmol/L at the time of the attack, symptoms improve with food or glucose supplementation, and continuous glucose monitoring (CGM) showed repeated hypoglycemia. Laboratory tests show a positive serum insulin autoantibody (IAA) and confirm the diagnosis of IAS. After admission, methimazole was stopped, propylthiouracil was replaced, the dietary structure was adjusted, and pronisolone 30 mg/d was given, and the hypoglycemic attack was gradually relieved. After 2 months of follow-up, there were no more symptoms of hypoglycemia and serum IAA levels were significantly reduced. IAS is one of the causes of recurrent hypoglycemia and can be triggered by the use of hydroxyxyl-containing drugs, most commonly methimazole. IAA testing is the mainstay of diagnosis and has a good prognosis after treatment.展开更多
目的探讨甲巯咪唑联合普萘洛尔治疗在甲状腺功能亢进症患者中的应用效果,并分析联合治疗对甲状腺功能与糖脂代谢水平的影响。方法回顾性分析2022年1月至2023年10月扬州大学附属兴化人民医院收治的甲状腺功能亢进症患者(99例)的临床资料...目的探讨甲巯咪唑联合普萘洛尔治疗在甲状腺功能亢进症患者中的应用效果,并分析联合治疗对甲状腺功能与糖脂代谢水平的影响。方法回顾性分析2022年1月至2023年10月扬州大学附属兴化人民医院收治的甲状腺功能亢进症患者(99例)的临床资料,依据不同治疗方法分为A组(49例,低碘饮食、戒烟、补充足量蛋白质等一般治疗联合甲巯咪唑治疗)与B组(50例,在A组治疗的基础上联合普萘洛尔治疗)。两组患者均治疗3个月。比较两组患者治疗3个月后临床疗效,治疗前、治疗3个月后甲状腺功能、糖脂代谢指标水平,治疗期间不良反应发生情况。结果与A组比,B组患者治疗3个月后临床总有效率更高;与治疗前比,两组患者治疗3个月后血清游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、空腹血糖(FPG)、餐后2 h血糖(2 h PG)水平均降低,且其中B组FT_(3)、FT_(4)水平均低于A组;促甲状腺激素(TSH)、甲状旁腺素(PTH)、低密度脂蛋白胆固醇(LDL-C)均升高,B组均高于A组(均P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论普萘洛尔与甲巯咪唑联合治疗,可改善患者甲状腺功能,调节脂代谢,对糖代谢影响较小,不会显著增加不良反应,安全性良好。展开更多
文摘随访一例因使用甲巯咪唑诱发胰岛素自身免疫综合征(IAS)的患者,分析患者临床资料及诊治过程,并对相关文献进行复习。患者服用甲巯咪唑4月后反复出现“心悸、乏力、大汗”等表现,伴有烦躁、易激动等焦虑情绪,多次就诊于我院急诊科,发作时血糖最低3.0 mmol/L,进食或补充葡萄糖后症状好转,持续葡萄糖监测示有反复低血糖发生。实验室检查示血清胰岛素自身抗体(IAA)阳性,确诊为IAS。入院后停用甲巯咪唑,改为丙硫氧嘧啶,调整饮食结构,予泼泥松30 mg/d,低血糖发作逐渐缓解。随访2个月,未再发生低血糖症状,血清IAA水平明显降低。IAS是发生反复低血糖的病因之一,可由服用含羟基药物诱发,以甲巯咪唑最为常见。IAA检测为诊断该病的主要依据,经治疗预后良好。A patient with methimazole-induced insulin autoimmune syndrome (IAS) was followed up with the analysis of his clinical data, diagnosis and treatment process, and a literature review was performed. After taking methimazole for 4 months, the patient repeatedly had “palpitations, fatigue, sweating”, accompanied by irritability, irritability and other anxious emotions, and visited the emergency department of our hospital many times, and the blood glucose was as low as 3.0 mmol/L at the time of the attack, symptoms improve with food or glucose supplementation, and continuous glucose monitoring (CGM) showed repeated hypoglycemia. Laboratory tests show a positive serum insulin autoantibody (IAA) and confirm the diagnosis of IAS. After admission, methimazole was stopped, propylthiouracil was replaced, the dietary structure was adjusted, and pronisolone 30 mg/d was given, and the hypoglycemic attack was gradually relieved. After 2 months of follow-up, there were no more symptoms of hypoglycemia and serum IAA levels were significantly reduced. IAS is one of the causes of recurrent hypoglycemia and can be triggered by the use of hydroxyxyl-containing drugs, most commonly methimazole. IAA testing is the mainstay of diagnosis and has a good prognosis after treatment.
文摘目的探讨甲巯咪唑联合普萘洛尔治疗在甲状腺功能亢进症患者中的应用效果,并分析联合治疗对甲状腺功能与糖脂代谢水平的影响。方法回顾性分析2022年1月至2023年10月扬州大学附属兴化人民医院收治的甲状腺功能亢进症患者(99例)的临床资料,依据不同治疗方法分为A组(49例,低碘饮食、戒烟、补充足量蛋白质等一般治疗联合甲巯咪唑治疗)与B组(50例,在A组治疗的基础上联合普萘洛尔治疗)。两组患者均治疗3个月。比较两组患者治疗3个月后临床疗效,治疗前、治疗3个月后甲状腺功能、糖脂代谢指标水平,治疗期间不良反应发生情况。结果与A组比,B组患者治疗3个月后临床总有效率更高;与治疗前比,两组患者治疗3个月后血清游离三碘甲状腺原氨酸(FT_(3))、游离甲状腺素(FT_(4))、空腹血糖(FPG)、餐后2 h血糖(2 h PG)水平均降低,且其中B组FT_(3)、FT_(4)水平均低于A组;促甲状腺激素(TSH)、甲状旁腺素(PTH)、低密度脂蛋白胆固醇(LDL-C)均升高,B组均高于A组(均P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P>0.05)。结论普萘洛尔与甲巯咪唑联合治疗,可改善患者甲状腺功能,调节脂代谢,对糖代谢影响较小,不会显著增加不良反应,安全性良好。
