摘要
目的:总结61例胰岛素瘤患者的临床特征,探讨定性及定位诊断方法。方法:对1992年至2019年中山大学孙逸仙纪念医院经病理确诊的61例胰岛素瘤患者的临床资料进行回顾性分析。结果:胰岛素瘤患者误诊率高达34.4%;70.5%患者出现典型Whipple三联征;当静脉血糖<3 mmol/L时,C肽≥200 pmol/L、胰岛素≥3.0 mU/L、胰岛素释放指数(IRI)≥0.3及修正IRI≥50的患者分别为100%、97.1%、91.2%和94.1%;在术前定位检查中,腹部彩超、CT、MRI、超声内镜的阳性率分别是46.3%、82.4%、86.8%和96.3%。结论:胰岛素瘤临床表现复杂多样,容易漏诊和误诊;当血糖<3 mmol/L,首选C肽≥200 pmol/L和胰岛素≥3.0 mU/L作为胰岛素瘤定性诊断标准。MRI可作为临床上无创定位检查的首选方法,超声内镜可进一步提高胰岛素瘤检出率。
Objective:To summarize the clinical characteristics and experience in the qualitative and localization diagnosis of insulinoma.Methods:A retrospective analysis was conducted on the clinical materials of 61 insulinoma patients confirmed by pathology from 1992 to 2019 at Sun Yat-sen Memorial Hospital.Results:34.4%of the patients were misdiagnosed,with 70.5%of patients exhibiting the typical Whipple′s triad.when blood glucose<3 mmol/L,C-peptide≥200 pmol/L,insulin≥3 mU/L,Insulin release index(IRI)≥0.3 and amended IRI≥50 occurred in 100%,97.1%,91.2%and 94.1%,respectively.The positive rates of examinations for localization before operation were transabdominal ultrasound 46.3%,CT 82.4%,MRI 86.8%and endoscopic ultrasonography 96.3%.Conclusions:The clinical presentation of insulinoma is complex and diverse,leading to frequent misdiagnosis and missed diagnosis.When blood glucose<3 mmol/L,C-peptide≥200 pmol/L and insulin≥3.0 mU/L should be prioritized as qualitative diagnostic criteria for in-sulinoma.MRI can be considered the primary choice for non-invasive localization examinations,and endoscopic ultrasound can further improve the detection rate of insulinoma.
作者
方晓玲
蒋映雪
姜烁
俞国盛
尤丽丽
陈映娜
劳国娟
FANG Xiao-ling;JIANG Ying-xue;JIANG Shuo;YU Guo-sheng;YOU Li-li;CHEN Ying-na;LAO Guo-juan(Department of Endocrinology,Sun Yat-sen Memorial Hospital,Sun Yat-sen University,Guangzhou,510120;Linzhi People's Hospital,Xizang)
出处
《岭南急诊医学杂志》
2024年第5期500-502,共3页
Lingnan Journal of Emergency Medicine
基金
广东省代谢性疾病(糖尿病)临床医学研究中心(2020B1111170009)
西藏自治区自然科学基金组团式援藏医学项目(XZ2024ZR-ZY097(Z))。
关键词
胰岛素瘤
临床特征
定性诊断
定位诊断
insulinoma
clinical characteristics
qualitative diagnosis
localization diagnosis
