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目的分析以低血糖为首发症状的胰岛素瘤的临床特征及诊断方法。方法从以低血糖症收治入院的91例病例中筛选出31例胰岛素瘤患者,对其相关临床资料进行回顾性分析。结果 31例胰岛素瘤患者中,21例空腹低血糖发作时胰岛素释放指数(IRI/G)>0.3。术前B超、CT以及MRI检查对胰岛素瘤的诊断阳性率分别为13.3%、57.7%和28.6%。15例进行手术治疗,14例发现肿瘤,且均为单发病灶,肿瘤位于胰头、尾部多于胰体部,肿瘤直径0.5～3cm。结论同步测定血清胰岛素原和β-羟丁酸的浓度有助于胰岛素、C肽等生化指标不典型的胰岛素瘤的定性诊断。48-h饥饿实验可取代72-h饥饿试验成为胰岛素瘤定性诊断的新标准。
Objective To analyze the clinical characteristics and diagnosis of insulinoma with hypoglycemia as the first symptom. Methods Thirty-one patients with insulinoma were screened from 91 cases admitted to hospital with hypoglycemia, and their clinical data were retrospectively analyzed. Results Among 31 patients with insulinoma, the insulin release index (IRI / G) was> 0.3 in 21 patients with fasting hypoglycemia. Preoperative B-ultrasound, CT and MRI examination of insulinoma positive rates were 13.3%, 57.7% and 28.6%. Fifteen patients underwent surgical treatment. Tumors were found in 14 patients and all were single lesions. The tumor was located in the head of the pancreas and the tail was more than the body of the pancreas. The diameter of the tumor was 0.5-3 cm. Conclusions Simultaneous determination of serum proinsulin and β-hydroxybutyrate concentration is helpful for the qualitative diagnosis of insulinoma, C-peptide and other atypical biopsy insulinoma. 48-h starvation experiment can replace the 72-h starvation test as a new standard for the qualitative diagnosis of insulinoma.