SUCCESSFUL IMMUNOSUPPRESSIVE THERAPY IN INSULIN RESISTANT DIABETES CAUSED BY ANTI-INSULIN RECEPTOR AUTOANTIBODIES
SUCCESSFUL IMMUNOSUPPRESSIVE THERAPY IN INSULIN RESISTANT DIABETES CAUSED BY ANTI-INSULIN RECEPTOR AUTOANTIBODIES
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DOI：
10.1210/jcem-44-1-15
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发表时间：
1977-01-01
影响因子：
5.8
通讯作者：
FLIER, JS
中科院分区：
文献类型：
--
作者：
KAWANISHI, K;KAWAMURA, K;FLIER, JS
一位45岁的非肥胖女性患者，既往无胰岛素服药史，在血清中没有抗胰岛素抗体的情况下，有极端的胰岛素抵抗和异常高的血浆免疫活性胰岛素。临床上，没有出现酮尿症。患者也有干燥S综合征的证据，其免疫学特征包括高丙种球蛋白血症、抗核抗体阳性、血沉加快和白细胞减少。血浆胰升糖素和C-肽升高，但未见其他内分泌异常。在该患者中，胰岛素抵抗似乎是由于抗胰岛素受体抗体所致，即使在1：500稀释的血清中也能检测到这种抗体。强的松龙和环磷酰胺的免疫抑制治疗导致血清丙种球蛋白水平下降，并伴随血糖水平的下降。免疫抑制治疗8个月后，糖尿病综合征完全消失，血清中不再检测到抗受体抗体。此外，胰岛素敏感性恢复正常。患者S在暂时停止环磷酰胺治疗和降低强的松龙剂量后糖耐量恶化。
A 45-yr-old, non-obese female patient with no previous history of insulin administration had extreme insulin resistance and abnormally high plasma immunoreactive insulin in the absence of anti-insulin antibodies in the serum. Clinically, there was no ketonuria. The patient also had evidence of Sjogren''s syndrome with several immunologic features including hypergammaglobulinemia, positive antinuclear antibodies, accelerated erythrocyte sedimentation rate and leukopenia. Plasma pancreatic glucagon and C-peptide were elevated, but other endocrinologic abnormalities were not present. In this patient the insulin resistance appeared to be due to anti-insulin receptor antibodies which could be detected even in 1:500 dilution of serum. Immunosuppressive therapy with prednisolone and cyclophosphamide resulted in a decreased level of serum gamma globulin and a concomitant decrease of blood glucose level. After immunosuppressive therapy for 8 mo., the diabetic syndrome disappeared completely and anti-receptor antibodies in the serum were no longer detectable. Furthermore, insulin sensitivity returned to normal. The patient''s glucose tolerance deteriorated after the temporary termination of cyclophosphamide treatment and the lowering of prednisolone dosage.