Schernthaner G
Department of Medicine I, Rudolfstiftung Hospital, Vienna, Austria.
Diabetes Care. 1993 Dec;16 Suppl 3:155-65. doi: 10.2337/diacare.16.3.155.
Immunological complications of insulin therapy have been evident since animal insulins became available for the treatment of diabetes mellitus in 1922. Insulin allergy has been particularly common, with local symptoms still occurring in approximately 5% of all patients. Insulin antibodies of high titers were observed in many patients treated with early insulin preparations containing proinsulin, C-peptide, and other peptide contaminants. Immunoglobulin G-insulin antibodies of very high levels can lead to immune-mediated insulin resistance, which is now extremely rare because of the widespread use of highly purified porcine insulin and human insulin preparations. Lipoatrophy, which was reported in 10-55% of patients treated with nonpurified bovine/porcine insulin preparations, has almost disappeared in patients since the advent of exclusive human insulin treatment. In view of the wide spectrum of immune-mediated complications of insulin therapy, much attention has been directed to the reduced immunogenicity and allergenicity of highly purified porcine insulins and the more recently available recombinant and semisynthetic human insulin preparations. Insulin antibodies of the immunoglobulin G and immunoglobulin E type can develop, however, in very low titers in patients treated exclusively with human insulin. Frequency and levels of immunoglobulin G insulin antibodies are identical in patients treated either with biosynthetic or semisynthetic human insulin preparations. Allergic symptoms to human insulin are now found in < 1% of de novo-treated patients, but still may occur when human insulin is used in the insulin-allergic patient. In summary, immunological complications of insulin therapy have decreased significantly during the last two decades and are now predominantly observed in patients with interrupted insulin therapy.
自1922年动物胰岛素可用于治疗糖尿病以来，胰岛素治疗的免疫并发症就已很明显。胰岛素过敏尤为常见，约5%的患者仍会出现局部症状。在许多接受含胰岛素原、C肽和其他肽类污染物的早期胰岛素制剂治疗的患者中，观察到了高滴度的胰岛素抗体。极高水平的免疫球蛋白G胰岛素抗体可导致免疫介导的胰岛素抵抗，由于高纯度猪胰岛素和人胰岛素制剂的广泛使用，这种情况现在极为罕见。脂肪萎缩在10%至55%接受非纯化牛/猪胰岛素制剂治疗的患者中曾有报道，自 exclusively human insulin treatment出现以来，患者中几乎已消失。鉴于胰岛素治疗的免疫介导并发症范围广泛，人们已将大量注意力转向高纯度猪胰岛素以及最近可得的重组和半合成人胰岛素制剂免疫原性和致敏性的降低。然而，仅接受人胰岛素治疗的患者中，免疫球蛋白G和免疫球蛋白E型胰岛素抗体仍可能以非常低的滴度出现。接受生物合成或半合成人胰岛素制剂治疗的患者中，免疫球蛋白G胰岛素抗体的频率和水平相同。现在，初治患者中对人胰岛素过敏症状的发生率<1%，但胰岛素过敏患者使用人胰岛素时仍可能出现过敏症状。总之，在过去二十年中，胰岛素治疗的免疫并发症已显著减少，现在主要见于胰岛素治疗中断的患者。
