非糖尿病患者药物性低血糖症的临床特点分析  

Clinical characteristics of drug-induced hypoglycemia in non-diabetic patients

作　　者：李佳 吴晗 李玉秀[1] 于淼[1] 金鹏飞[2] Li Jia;Wu Han;Li Yuxiu;Yu Miao;Jin Pengfei(Department of Endocrinology,Peking Union Medical College Hospital,Chinese Academy of Medical Sciences ＆ Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院北京协和医学院北京协和医院内分泌科,100730 [2]北京医院药学部国家老年医学研究中心

出　　处：《中华糖尿病杂志》2018年第10期654-657,共4页CHINESE JOURNAL OF DIABETES MELLITUS

摘　　要：目的探讨非糖尿病患者药物性低血糖症的临床特点及相关因素。方法回顾1例含口服降糖药物成分的壮阳保健品所致药物性低血糖症患者的诊疗经过，并总结北京协和医院2008年1月至2017年12月收治的非糖尿病患者药物性低血糖症案例的临床资料，分析其临床特点。结果本例患者壮阳保健品经高效液相色谱法和液相色谱-四级杆-飞行时间质谱检测出格列本脲、苯乙双胍和西地那非，停用该药后未再发低血糖症，证实为药物性低血糖症。在北京协和医院近10年收治的12例非糖尿病患者药物性低血糖症案例中，发病年龄为13～76岁（中位年龄64岁），男女比例为11：l；其中8例行药物成分测定，最常见者为格列本脲（100％），其次为格列喹酮、二甲双胍、苯乙双胍等。药物性低血糖症患者多无严重肝肾等基础疾病，发作时间无规律性，发作时血糖多低于2．0mmol／L，影像学检查无明显异常；详细询问病史，常可追溯发作前有可疑用药史。结论低血糖症的临床诊治中需排查药物性低血糖症，详细询问用药史并进行成分测定对明确诊断至关重要。Objective To explore the clinical characteristics of drug-induced hypoglycemia in non- diabetic patients. Methods A case of hypoglycemia caused by sexual enhancement medication containing oral antidiabetie agents was presented. Data of drug-induced hypoglycemia in non-diabetic patients admitted in Peking Union Medical College Hospital from January 2008 to December 2017 were collected and analyzed. Results Glibenclamide, phenformin and sildenafil were confirmed by high performance liquid chromatography and liquid chromatography-quadrupole-time of flight mass spectrometry in the sexual enhancement medication, and no recurrent hypoglycemia occurred after discontinuation of the agent. In the past 10 years, a total of 12 cases were admitted in Peking Union Medical College Hospital with the diagnose of drug-induced hypoglycemia in non-diabetic patients. The onset age was 13-76 years old with the median of 64 years old, and the ratio of male to female was 11 ： 1. The drug components test was performed in 8 cases and demonstrated that glyhuride was the most common agent （100%）, followed by gliquidone, metformin and phenformin. The common features of drug-induced hypoglycemia in non-diabetic patients were as the follows ： no history of sever hepatic and renal diseases, irregular seizures onset pattern, plasma glucose level often less than 2.0 mmol/L at episodes, no significant imaging abnormalities, suspected medication history. Conclusion Drug-induced hypoglycemia should be considered in the clinical setting of hypoglycemia in non-diabetic patients. Detailed medication history and drug components test are crucial for the diagnosis and management.

关 键 词：低血糖症 药物 格列本脲 苯乙双胍 西地那非 

分 类 号：R587.3[医药卫生—内分泌]