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.