Case Analysis in the Literature of Clopidogrel-Related Insulin Autoimmune Syndrome

WANG Siwen; GAO Huan; SONG Yanqing; WANG Xiangfeng

doi:10.14009/j.issn.1672-2124.2022.09.026

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Case Analysis in the Literature of Clopidogrel-Related Insulin Autoimmune Syndrome

更新时间：2023-04-16

- Case Analysis in the Literature of Clopidogrel-Related Insulin Autoimmune Syndrome
- Vol. 22, Issue 9, Pages: 1142-1144(2022)
- 作者机构：
  
  吉林大学第一医院药学部
- 作者简介：
- 基金信息：
- DOI：10.14009/j.issn.1672-2124.2022.09.026
  CLC： R593.2
- Published：2022，
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WANG Siwen, GAO Huan, SONG Yanqing, et al. Case Analysis in the Literature of Clopidogrel-Related Insulin Autoimmune Syndrome. [J]. 22(9):1142-1144(2022)
DOI：

WANG Siwen, GAO Huan, SONG Yanqing, et al. Case Analysis in the Literature of Clopidogrel-Related Insulin Autoimmune Syndrome. [J]. 22(9):1142-1144(2022) DOI： 10.14009/j.issn.1672-2124.2022.09.026.

摘要

目的：探讨氯吡格雷相关胰岛素自身免疫综合征(IAS)的临床特点，为临床合理用药提供参考。方法：检索中国知网、维普数据库、万方数据库、PubMed和Embase等数据库(截至2021年4月)

收集氯吡格雷相关IAS的病例报告类文献，提取患者相关信息[性别、年龄、发病时血糖水平、联合用药、胰岛素水平、C肽水平、干预措施、人类白细胞抗原(HLA)基因分型以及转归]进行描述性统计分析。结果：共收集到氯吡格雷相关IAS患者6例，包括澳大利亚1例、美国1例、日本2例和我国2例，均为男性患者，年龄63～84岁；其中单独应用氯吡格雷4例，氯吡格雷与其他药物联合应用2例。6例患者发病后，均停用氯吡格雷；其中2例患者停药并调整饮食结构后好转，3例患者停药并使用药物治疗(糖皮质激素、阿卡波糖)后好转，1例患者使用药物治疗无效而进行血浆置换后好转。6例患者在停药或治疗后5～10个月内进行随访或复查，均未再出现低血糖症状。结论：氯吡格雷相关IAS为氯吡格雷的罕见不良反应，与HLA-DR4密切相关，本研究中6例患者的基因型包括HLA-DRB1*04、HLA-DRB1*0404、HLA-DRB1*0406、HLA-DRB1*0404/0901、HLA-DRB1*0403与0701

HLA-DQB1*0302与0202;6例患者均在服用氯吡格雷至少2周后出现非糖尿病性低血糖症状，主要临床表现为高胰岛素血症、低血糖和胰岛素自身抗体水平升高，视病情程度给予治疗，预后良好。

Abstract

OBJECTIVE: To probe into the clinical characteristics of clopidogrel-related insulin autoimmune syndrome（IAS）

so as to provide reference for the rational drug sue in clinic. METHODS: CNKI

VIP

Wanfang Data

PubMed and Embase databases were retrieved to collect the case report literature of clopidogrel-related IAS（till Apr. 2021）. Relevant information of patients（gender

age

blood glucose level at onset

drug combination

insulin level

C-peptide level

intervention measures

HLA genotyping and outcome） were extracted for descriptive statistical analysis. RESULTS: A total of 6 patients with clopidogrel-related IAS were collected

including 1 case from Australia

1 case from the United States

2 cases from Japan and 2 cases from China. All patients were male

aged from 63 to 84 years old

4 cases were treated with clopidogrel alone and 2 cases were used in combination with other drugs. Clopidogrel was discontinued in 6 patients after the onset. Among them

2 patients were improved after drug withdrawal and dietary adjustment

3 patients were improved after drug withdrawal and drug treatment（glucocorticoid and acarbose）

and 1 patient was improved after plasma exchange due to ineffective drug treatment. Six patients were followed up or reexamined within 5 to 10 months after drug withdrawal or treatment

and no symptoms of hypoglycemia recurred. CONCLUSIONS: Clopidogrel-related IAS is a rare adverse drug reaction of clopidogrel and is closely related to HLA-DR4. The genotypes of the 6 patients in this study include HLA-DRB1*04

HLA-DRB1*0404

HLA-DRB1*0406

HLA-DRB1*0404/0901、HLA-DRB1*0403 and 0701

HLA-DQB1*0302 and 0202. Six patients develop non-diabetic hypoglycemia after taking clopidogrel for at least 2 weeks. The main clinical manifestations are hyperinsulinemia

hypoglycemia and elevated insulin autoantibody levels.

关键词

氯吡格雷胰岛素自身免疫综合征人类白细胞抗原

Keywords

ClopidogrelInsulin autoimmune syndromeHuman leukocyte antigen

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