Roffman D S, Wiser T H
Am J Hosp Pharm. 1980 Aug;37(8):1105-10.
Two cases of insulin resistance are described, and recent developments in the pathogenesis and treatment of insulin resistance are reviewed. Both immune and nonimmune types of insulin resistance have been described. Immune resistance is related to the presence of circulating antibodies directed against exogenous insulin or the insulin receptor sites. Nonimmune resistance is associated with obesity, ketoacidosis, infection, or endocrinopathies. Treatment of insulin-resistant diabetics can include proper diet and weight control; use of insulin in large quantities; selection of less antigenic forms of insulin, such as pork, fish, or sulfated insulin; oral hypoglycemics such as tolbutamide; and immunosuppressive therapy with corticosteroids. The production of human insulin by recombinant DNA technology promises benefits to patients with high levels of antibodies directed against insulin from animal sources. True insulin resistance is a rare phenomenon, which must be documented adequately before vigorous treatment is considered.
本文描述了两例胰岛素抵抗病例，并综述了胰岛素抵抗发病机制和治疗方面的最新进展。胰岛素抵抗分为免疫性和非免疫性两种类型。免疫性抵抗与针对外源性胰岛素或胰岛素受体位点的循环抗体的存在有关。非免疫性抵抗与肥胖、酮症酸中毒、感染或内分泌疾病有关。胰岛素抵抗型糖尿病的治疗方法包括合理饮食和体重控制；大量使用胰岛素；选择抗原性较低的胰岛素形式，如猪胰岛素、鱼胰岛素或硫酸化胰岛素；口服降糖药，如甲苯磺丁脲；以及使用皮质类固醇进行免疫抑制治疗。通过重组DNA技术生产人胰岛素有望为那些针对动物来源胰岛素产生高水平抗体的患者带来益处。真正的胰岛素抵抗是一种罕见现象，在考虑积极治疗之前必须有充分的记录。
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