Ganz M A, Unterman T, Roberts M, Uy R, Sahgal S, Samter M, Grammer L C
Department of Medicine, Northwestern University Medical School, Chicago, Ill.
J Allergy Clin Immunol. 1990 Jul;86(1):45-51. doi: 10.1016/s0091-6749(05)80122-8.
Insulin allergy and antibody-mediated resistance may complicate therapy with animal insulins. We describe a 53-year-old man manifesting both resistance and persistent systemic allergy despite treatment with recombinant human insulin. Insulin resistance and symptoms of allergy appeared in this patient several months after initiating therapy with mixed beef-pork insulin, as is often the case. Symptoms initially improved, but persisted, and then worsened again, despite continuous human insulin therapy. Total insulin-binding capacity by Scatchard analysis, high plasma insulin-binding capacity, and specific anti-insulin antibody levels were consistent with an immunologic form of insulin resistance. Glucocorticoid therapy was required both to reduce allergic findings and to restore glycemic control. Although recently available human insulins may be less immunogenic than animal forms, immune responses to exogenous human insulin still may pose significant clinical problems.
胰岛素过敏和抗体介导的抵抗可能会使动物胰岛素治疗变得复杂。我们描述了一名53岁男性，尽管使用重组人胰岛素进行治疗，但仍表现出抵抗和持续性全身过敏。与常见情况一样，该患者在开始使用混合牛胰岛素-猪胰岛素治疗数月后出现胰岛素抵抗和过敏症状。尽管持续使用人胰岛素治疗，症状最初有所改善，但仍持续存在，然后再次恶化。通过Scatchard分析得出的总胰岛素结合能力、高血浆胰岛素结合能力以及特异性抗胰岛素抗体水平与免疫性胰岛素抵抗相符。需要使用糖皮质激素治疗以减轻过敏表现并恢复血糖控制。尽管最近可用的人胰岛素的免疫原性可能低于动物胰岛素，但对外源性人胰岛素的免疫反应仍可能带来重大临床问题。
