Wilkin T, Keller U, Diaz J L, Armitage M
General Hospital, Southampton, U.K.
Diabetes Res Clin Pract. 1990 Jan;8(2):131-6. doi: 10.1016/0168-8227(90)90023-m.
The insulin autoimmune syndrome is characterised by high titres of autoantibody to insulin, a high circulating concentration of total insulin and later, reactive hypoglycaemia. We have studied a patient with this syndrome whose insulin autoantibody bound exclusively human insulin. This permitted us to investigate the disappearance of bound (human) and unbound (porcine) insulin in the same patient, using i.v. injections of 0.075 U/g of each insulin on separate days. The peak plasma free insulin concentration following porcine insulin was four times greater than that following the same dose of human insulin. The plasma disappearance half-time of porcine insulin following injection was 11 min compared with 32 min following human insulin injection, and the area beneath the disappearance curve of free insulin during the 120 min of sampling was greater for porcine insulin by a factor of 3.15. The nadir in plasma glucose occurred at 45 min following porcine insulin and at 90 min following human insulin injection. The restoration of basal glucose concentration was correspondingly slower following human insulin, but the absolute fall in glucose achieved was no different. There was no evidence of insulin resistance. Insulin autoantibodies can seriously disturb the kinetics and effect of free insulin.
胰岛素自身免疫综合征的特征是存在高滴度的胰岛素自身抗体、循环中总胰岛素浓度升高，以及后期出现反应性低血糖。我们研究了一名患有该综合征的患者，其胰岛素自身抗体仅与人类胰岛素结合。这使我们能够在同一患者中研究结合型（人类）胰岛素和未结合型（猪）胰岛素的消失情况，在不同日期分别静脉注射每克体重0.075单位的每种胰岛素。注射猪胰岛素后血浆游离胰岛素浓度峰值是注射相同剂量人类胰岛素后峰值的四倍。注射后猪胰岛素的血浆消失半衰期为11分钟，而人类胰岛素注射后为32分钟，并且在120分钟采样期间游离胰岛素消失曲线下的面积猪胰岛素比人类胰岛素大3.15倍。血浆葡萄糖最低点在注射猪胰岛素后45分钟出现，在注射人类胰岛素后90分钟出现。人类胰岛素注射后基础葡萄糖浓度恢复相应较慢，但葡萄糖的绝对下降幅度并无差异。没有胰岛素抵抗的证据。胰岛素自身抗体可严重干扰游离胰岛素的动力学和作用。
