摘要
目的本文旨在总结僵人综合征合并成人隐匿性自身免疫糖尿病（LADA）患者的临床特征。方法2016年4月收治一例“进行性躯干肌肉僵硬、强直伴阵发痛性痉挛3年”的6l岁男性，入院前2年曾诊断为“2型糖尿病”，初期服用“二甲双胍”和“阿卡波糖”，血糖控制尚可。2年后检查空腹血糖15．29mmol／L，糖化血红蛋白（HbA1c）10．60％，谷氨酸脱羧酶抗体（GADA）39．0mU／L，胰岛功能提示绝对缺乏，抗甲状腺球蛋白（TG）抗体1044mU／L。结果予巴氯芬、氯硝西泮片等治疗后，肌肉僵直减轻。胰岛素治疗3个月后，复查HbA1c 7．4％，GADA36．4mU／L，胰岛功能仍提示绝对缺乏，抗TG抗体1068mU／L。文献复习发现GADA参与LADA、僵人综合征、自身免疫性甲状腺炎等多种自身免疫病的发病机制。结论体内较高滴度的GADA可能触发多种自身免疫性抗原，导致僵人综合征、LADA等数病并存。推荐对伴有神经症状的糖尿病患者筛查胰岛自身抗体以明确分型并指导治疗。
Objective To summarize the clinical features in a ease of stiffman syndrome combined with latent autoimmune diabetes in adults （LADA）. Methods A 61-year old male patient who presented with progressive trunk muscle stiffness, ankylosis and paroxysmal painful spasm for 3 years was admitted to hospital in April 2016. He was diagnosed with type 2 diabetes 2 years prior and initially stabilized by oral medicine of metformin and aearbose. His fasting plasma glucose （FPG） was 15.29 mmol/L, glyeosylated hemoglobin （HbA1c） was 10.60%, glutamic acid decarboxylase antibody （GADA） was 39.0 mU/L, thyroid globulin （TG） antibody was 1 044 mU/L and he presented with absolute insulin deficiency. Results Clonazepam and baclofen were used to relieve muscle stiffness. After insulin treatment for 3 months, the patient＇s HbA1c was 7.4%, GADA was 36.4 mU/L, TG antibody was 1 068 mU/L and insulin deficiency was persistant. Literature review revealed that GADA was involved in the pathogenesis of LADA, stiffman syndrome, thyroiditis and other autoimmune diseases. Conclusion The result shows extremely high titers of GADA can trigger multiple autoimmune antigen and result in stiffman syndrome, LADA concomitant with other autoimmune diseases. It is recommended that diabetic patients with neurological symptoms should be screened for islet autoantibodies to identify the types of the disease and guide treatment.
作者
李萍
梁琳琅
陈若然
张景华
夏程
陈会生
Li Ping Liang Linlang Chen Ruoran Zhang Jinghua Xia Cheng Chen Huisheng(Department of Endocrinology, General Hospital of Shenyang Military Command, Shenyang 110016, China)
出处
《中华糖尿病杂志》
CAS
CSCD
2017年第1期50-53,共4页
CHINESE JOURNAL OF DIABETES MELLITUS
