1例胰岛素致相关急性痛性神经病变的案例分析  

A case analysis of acute painful neuropathy caused by insulin

作　　者：张倩影 汤智慧[2] 肖彦革[3] ZHANG Qian-ying;TANG Zhi-hui;XIAO Yan-ge(Department of Pharmacy,North China University of Science and Technology Affiliated Hospital,Tangshan 063000,China;Department of Clinical Pharmacy Center,PLA General Hospital,Beijing 100853,China;Department of Pharmacy,People's Hospital of Anyang,Anyang 455000,China)

机构地区：[1]华北理工大学附属医院药学部,河北唐山063000 [2]解放军总医院临床药学中心,北京100853 [3]安阳市人民医院药剂科,河南安阳455000

出　　处：《中国药物应用与监测》2018年第2期118-120,共3页Chinese Journal of Drug Application and Monitoring

基　　金：解放军总医院临床科研扶持基金项目(2015FC-CXYY-2002)

摘　　要：1例29岁男性患者,既往体健,主因手足及双下肢剧烈疼痛2个月入院。入院后诊断为"2型糖尿病、糖尿病周围神经病变"。患者初次诊断为"糖尿病",给予精蛋白生物合成人胰岛素注射液(预混30R)联合格列美脲片降糖治疗18 d后,空腹血糖从23.14 mmol·L^(-1)降至6 mmol·L^(-1)。之后患者无明显诱因出现手足剧烈针刺样疼痛,自行服用洛芬待因片,普瑞巴林胶囊,疼痛稍缓解。患者入院,给予精蛋白生物合成人胰岛素注射液(预混30R)(早餐前28~34 IU、晚餐前18 IU)降糖治疗,α-硫辛酸注射液(600 mg,qd)、甲钴胺注射液(500μg,qd)、普瑞巴林胶囊(75 mg,bid)营养神经、止痛治疗。患者血糖控制可,四肢疼痛缓解不明显,行动受限。12月2日加用依帕司他胶囊(50 mg,tid)、木丹颗粒(1袋,tid)抗痛性神经病变治疗,心理科会诊加用度洛西汀肠溶胶囊(60 mg,qd)抗抑郁治疗。之后患者情绪较前平稳,疼痛较前明显好转,行动不受限制,出院。临床药师考虑该患者的急性痛性神经病变为胰岛素快速降糖治疗所致。A 29-year-old male patient without medical history was hospitalized because of severe pain in hands,feet and legs for 2 months.The patient was diagnosed as type 2 diabetes and diabetic perineuropathy.The patient was firstly diagnosed as diabetes and the fasting plasma glucose was reduced from 23.14 mmol·L-1 to 6 mmol·L-1 after 18 days treatment with isophane protamine biosynthetic human insulin injection(pre-mixed 30R)and glimepiride.The patient developed acute acupuncture-like pain with no obvious incentive.And the pain was slightly relieved after taking pregabalin capsules and ibuprofen and codeine phosphate tablets.After admission,the patient was treated with isophane protamine biosynthetic human insulin injection(pre-mixed 30R)(28– 34 IU a.j.,18 IU ant.coen),α-lipoic acid injection(600 mg,qd),mecobalamin injection(500μg,qd),pregabalin capsules(75 mg,bid).The blood glucose of the patient was controlled while pain of limbs persisted and the patient had limited movement.Two days later,epalrestat capsules(50 mg,tid)and Mudan granules(1 bag,tid)were added for painful neuropathy and duloxetine hydrochloride enteric capsules(60 mg,qd)was added for antidepression according to the consultation of psychological department.The pain of limbs was obviously improved.The patient was discharged out without limited movement.The acute painful neuropathy of this patient might be associated with rapid decline of blood glucose caused by insulin.

关 键 词：胰岛素 急性痛性神经病变 糖尿病 药品不良反应 

分 类 号：R969.3[医药卫生—药理学]