Daniel Amanda L, Houlihan Josetta L, Blum Janice S, Walsh James P
Division of Endocrinology and Metabolism, Indiana University School of Medicine, Indianapolis, Indiana, USA.
Endocr Pract. 2009 Mar;15(2):153-7. doi: 10.4158/EP.15.2.153.
To report a rare case of diabetes caused by type B insulin resistance due to development of insulin receptor autoantibodies during treatment of hepatitis C with interferon-alpha and ribavirin.
Clinical and laboratory findings in the case are presented. The literature on type B insulin resistance and interferon-induced autoimmunity is reviewed.
A 55-year-old African American man with hepatitis C was treated with interferon and ribavirin. Eight months later, he presented with rapid onset of hyperglycemia, profound weakness, and weight loss. Severe hyperglycemia persisted despite insulin infusion rates as high as 125 U/h. The presence of insulin receptor autoantibodies was confirmed by immunoprecipitation of recombinant human insulin receptor with patient serum. Assays for autoantibodies to islet cell antigens and glutamic acid decarboxylase were negative. The interferon and ribavirin were discontinued. His insulin requirement spontaneously declined to low levels over a 6-month period. Two years after discharge of the patient, insulin receptor autoantibodies could no longer be demonstrated in his serum. He remains euglycemic and is no longer taking insulin.
This case demonstrates that type B insulin resistance can occur as a complication of interferon-alpha therapy. To our knowledge, this is the first reported case in the United States of type B insulin resistance with development of insulin receptor autoantibodies during treatment with interferon-alpha.
报告一例罕见的因丙型肝炎患者在接受α干扰素和利巴韦林治疗期间出现胰岛素受体自身抗体而导致的B型胰岛素抵抗性糖尿病病例。
介绍该病例的临床和实验室检查结果，并对B型胰岛素抵抗和干扰素诱导的自身免疫相关文献进行综述。
一名55岁的非裔美国男性丙型肝炎患者接受了干扰素和利巴韦林治疗。八个月后，他迅速出现高血糖、极度虚弱和体重减轻。尽管胰岛素输注速率高达125 U/h，但严重的高血糖仍持续存在。通过用患者血清对重组人胰岛素受体进行免疫沉淀，证实了胰岛素受体自身抗体的存在。胰岛细胞抗原和谷氨酸脱羧酶自身抗体检测均为阴性。停用了干扰素和利巴韦林。在6个月的时间里，他的胰岛素需求量自发下降至低水平。患者出院两年后，其血清中不再能检测到胰岛素受体自身抗体。他的血糖保持正常，不再服用胰岛素。
该病例表明，B型胰岛素抵抗可作为α干扰素治疗的并发症出现。据我们所知，这是美国首例报道的在α干扰素治疗期间出现胰岛素受体自身抗体的B型胰岛素抵抗病例。
