目的 分析甲巰咪唑致胰島素自身免疫綜合征（IAS）臨床特點與發(fā)生規(guī)律，為適宜人群篩查及合理用藥提供參考。方法 檢索PubMed、EBSCO、中國知網(wǎng)（CNKI）、萬方醫(yī)學(xué)網(wǎng)及維普中文期刊（VIP）等數(shù)據(jù)庫中有關(guān)甲巰咪唑致胰島素自身免疫綜合征（IAS）的個案報道，并對相關(guān)指標(biāo)進(jìn)行統(tǒng)計分析和關(guān)聯(lián)性評價。檢索時間為建庫至2022年9月。結(jié)果 共得到27篇個案報道，中文19篇，英文8篇，文獻(xiàn)質(zhì)量評價均較高；發(fā)生IAS共計30例，其中女性風(fēng)險高于男性（80.00% vs 20.00%），41～60歲年齡層（36.67%）、自由職業(yè)者（42.10%）發(fā)生占比最高，其次患者有過治療中斷或停藥史也會影響IAS的發(fā)生；誘導(dǎo)期以21～30 d為主，占比37.04%，且相較于聯(lián)合用藥，單次給藥差異有顯著性（63.33% vs 23.33%）；關(guān)聯(lián)性評價肯定4例（13.33%），很可能20例（66.67%），可能6例（20.00%）。結(jié)論 藥學(xué)門診或臨床醫(yī)生在對甲亢患者開具甲巰咪唑時，開展必要的藥物流行病學(xué)問詢可有效降低患者服用甲巰咪唑致IAS的發(fā)生風(fēng)險。

Objective To analyze the clinical characteristics and occurrence regularity of insulin autoimmune syndrome induced by methimazole,and to provide reference for suitable population screening and rational drug use.Methods Case reports of insulin autoimmune syndrome (IAS) caused by methimazole were retrieved from PubMed,EBSCO,CNKI,Wanfang Medical Network,VIP,and other databases,and the relevant indicators were statistically analyzed and the correlation was evaluated.The retrieval time is from the establishment of the database to September 2022.Results There were 27 case reports,19 in Chinese and 8 in English.The literature quality evaluation was high.A total of 30 patients had IAS,among which female patients were at higher risk than male patients (80.00%vs 20.00%),aged 41 to 60 years old (36.67%),and freelancers (42.10%) accounted for the highest proportion.In addition,the occurrence of IAS was also affected by patients'history of treatment interruption or drug withdrawal.The induction period was mainly 21 to 30 d,accounting for 37.04%,and compared with the combination medication,the difference of single medication was significant (63.33%vs 23.33%).The association evaluation was positive in 4 cases (13.33%),probable in 20 cases (66.67%),and probable in 6 cases (20.00%).Conclusion When methimazole is administered to hyperthyroidism patients in pharmaceutical outpatient departments or clinicians,necessary pharmacoepidemiological inquiries can effectively reduce the risk of insulin autoimmune syndrome caused by methimazole administration in patients.

R977

國家自然科學(xué)基金資助項目(82004073);四川省科技廳科技計劃苗子工程重點項目(2022JDRC0146);四川省醫(yī)學(xué)會(恒瑞)科研基金專項科研課題(2021HR26)