Tsokos G C, Gorden P, Antonovych T, Wilson C B, Balow J E
Ann Intern Med. 1985 Feb;102(2):176-81. doi: 10.7326/0003-4819-102-2-176.
The frequency of various autoimmune features in 14 patients with insulin-resistant diabetes mellitus (type B) was reviewed. Twelve patients had leukopenia, high titers of antinuclear antibodies (speckled pattern), and hypoalbuminemia; 11 had elevated serum levels of IgG and high erythrocyte sedimentation rates; 7 had proteinuria and high serum levels of antibodies to DNA; and 5 had alopecia and elevated serum levels of IgA. Lupus erythematosus preparations were negative in all patients. Eight patients met the conventional criteria for the diagnosis of systemic lupus erythematosus. Three patients developed renal involvement while under care at the National Institutes of Health. Kidney tissue samples showed proliferative and membranous glomerulonephritis, tubulointerstitial nephritis, and electron-dense deposits similar to those of lupus nephritis. The lupus nephritis in these 3 patients appeared to be independent of the level of insulin-receptor antibody and glucose dysmetabolism. This study documents the presence of systemic lupus erythematosus in a large proportion of patients with insulin resistance due to autoantibodies to insulin receptors and emphasizes that careful monitoring of such patients for major complications of lupus nephritis is warranted.
回顾了14例胰岛素抵抗型糖尿病（B型）患者各种自身免疫特征的发生频率。12例患者有白细胞减少、高滴度抗核抗体（斑点型）和低白蛋白血症；11例患者血清IgG水平升高和红细胞沉降率加快；7例患者有蛋白尿和高血清DNA抗体水平；5例患者有脱发和血清IgA水平升高。所有患者狼疮红斑制剂检查均为阴性。8例患者符合系统性红斑狼疮的传统诊断标准。3例患者在美国国立卫生研究院接受治疗时出现肾脏受累。肾脏组织样本显示增殖性和膜性肾小球肾炎、肾小管间质性肾炎以及与狼疮性肾炎相似的电子致密沉积物。这3例患者的狼疮性肾炎似乎与胰岛素受体抗体水平和糖代谢异常无关。本研究证明，由于胰岛素受体自身抗体，大部分胰岛素抵抗患者存在系统性红斑狼疮，并强调对此类患者进行狼疮性肾炎主要并发症的仔细监测是必要的。
