氯吡格雷致胰岛素自身免疫综合征一例

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患者老年男性,因“发作性出汗、心悸22d”就诊,否认严重肝、肾功能不全病史,否认外源性胰岛素用药史,否认胰腺占位及手术史,有氯吡格雷服药史。多次查随机血浆葡萄糖1 000 mIU/L,胰岛素自身抗体(IAA)(+)。人类白细胞抗原分型:DRB1*0403与0701,DQB1*0302与0202。停用氯吡格雷,调节饮食结构,口服阿卡波糖后低血糖症状逐渐缓解,出院5个月后复查血清胰岛素及C-肽明显下降,IAA转阴,遂停用阿卡波糖,减少进餐次数,发作性出汗及心悸未再发生。
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