利妥昔单抗成功治疗一名患有抗体介导的胰岛素抵抗综合征的2型糖尿病患者：病例报告。
Successful treatment with rituximab of a type 2 diabetes patient with antibody-mediated insulin resistance syndrome: A case report.
作者信息
Çakmak Ramazan, Tekin Sakin, Hacişahinoğullari Hülya, Mutlu Ümmü, Çaklili Özge Telci, Nasibopva Vefa Seferova, Ok Ayşe Merve, Saribeyliler Göktuğ, Araz Mustafa, Yalin Gülşah Yenidünya, Selçukbiricik Özlem Soyluk, Gül Nurdan, Üzüm Ayşe Kubat, Karşidağ Kubilay, Dinççağ Nevin, Yilmaz Mehmet Temel, Satman İlhan
机构信息
Division of Endocrinology and Metabolism Disease, Department of Internal Medicine, Istanbul Faculty of Medicine, Istanbul University, Istanbul, Turkey.
Division of Endocrinology and Metabolism Disease, Department of Internal Medicine, Gaziantep University, Gaziantep, Turkey.
出版信息
Medicine (Baltimore). 2025 Jul 18;104(29):e43501. doi: 10.1097/MD.0000000000043501.
RATIONALE
Insulin antibody-mediated insulin resistance is a rare autoimmune mechanism that can cause severe hyperglycemia.
PATIENT CONCERNS
A 52-year-old male patient was admitted to our hospital with complaints of polydipsia, polyuria, and weight loss (8 kg in 6 months). He was diagnosed with type 2 diabetes mellitus at age 33.
DIAGNOSES
Type 2 diabetes mellitus with antibody-mediated insulin resistance syndrome.
INTERVENTIONS
Rituximab infusion in a 500 mg dose was given 2 times in a 2-week interval.
OUTCOMES
A significant response was achieved 1 month later with fasting plasma glucose: 120 mg/dL (6.7 mmol/L), glycosylated hemoglobin A1c: 7.6% (59.6 mmol/mol), and anti-insulin antibodies: 0.001 U/mL. Clinically improved response persisted for about 6 months.
LESSONS
Clinicians should be aware of the antibody-mediated insulin resistance, recognize suggestive signs and symptoms, pursue appropriate diagnostic evaluation, and treatment approach.
原理
胰岛素抗体介导的胰岛素抵抗是一种罕见的自身免疫机制，可导致严重的高血糖症。
患者情况
一名52岁男性患者因多饮、多尿和体重减轻（6个月内减轻8公斤）入院。他33岁时被诊断为2型糖尿病。
诊断
2型糖尿病伴抗体介导的胰岛素抵抗综合征。
干预措施
以500毫克剂量静脉输注利妥昔单抗，每2周给药1次，共2次。
结果
1个月后取得显著疗效，空腹血糖为120毫克/分升（6.7毫摩尔/升），糖化血红蛋白A1c为7.6%（59.6毫摩尔/摩尔），抗胰岛素抗体为0.001单位/毫升。临床改善反应持续约6个月。
经验教训
临床医生应了解抗体介导的胰岛素抵抗，识别提示性的体征和症状，进行适当的诊断评估和治疗。
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