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.
Abstract
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 pa-tients 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-pep-tide≥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 presenta-tion 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 ultra-sound can further improve the detection rate of insulinoma.
基金项目
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-ZY097Z)
维普
万方数据