21例达格列净致糖尿病酮症不良反应分析  

Analysis of 21 cases of diabetic ketosis induced by dapagliflozin

作　　者：谈仪炯 丁晓颖[2] 申婷婷 王育璠[2] 范能光[2] TAN Yi-jiong;DING Xiao-ying;SHEN Ting-ting;WANG Yu-fan;FAN Neng-guang(Department of Clinical Pharmacy,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080;Department of Endocrinology and Metabolism,Shanghai General Hospital,Shanghai Jiao Tong University,Shanghai 200080)

机构地区：[1]上海交通大学附属第一人民医院临床药学科,上海200080 [2]上海交通大学附属第一人民医院内分泌代谢科,上海200080

出　　处：《中南药学》2020年第12期2084-2088,共5页Central South Pharmacy

基　　金：国家自然科学基金(No.81870594);国家自然科学基金青年科学基金项目(No.81400785);上海交通大学“交大之星”医工滚动支持项目(No.YG2019GD05)。

摘　　要：目的研究达格列净致2型糖尿病患者出现酮症的规律和特点,为临床合理用药提供参考。方法收集2019年11月—2020年9月本院内分泌科住院期间服用达格列净后出现酮症的2型糖尿病患者21例,对患者的临床资料和治疗转归进行统计分析。结果 21例患者中11例男性、10例女性,9例糖尿病病程10年以上,15例糖化血红蛋白大于9%,6例胰岛功能较差;患者合并使用的降糖药物较多,使用最多的为阿卡波糖、二甲双胍和利拉鲁肽注射液;诱发酮症的潜在危险因素包括不规律饮食、情绪焦虑、停用或明显减少胰岛素注射剂量;酮症发生在服用达格列净后的1~7 d内;临床表现以恶心、呕吐等胃肠道反应为主,少部分伴有精神萎靡、乏力症状。酮症时平均血糖为6.8 mmol·L^-1,最高为10.7 mmol·L^-1。血气分析结果提示4例患者发生了酮症酸中毒;经停用达格列净、补液、小剂量胰岛素静脉滴注等治疗后,症状均好转,酮体在1~4 d内转阴。结论 2型糖尿病患者服用达格列净后可能出现酮症,尤其是当患者糖尿病病程较长、胰岛功能较差,或合并使用阿卡波糖、二甲双胍、利拉鲁肽注射液等容易引起胃肠道反应的降糖药物的情况下。如患者服用达格列净后出现恶心、呕吐、乏力、精神萎靡等非特异性症状时应加强酮体的监测,酮体阳性时及时采取治疗措施,保障临床用药安全。Objective To determine the characteristics of ketosis in patients with type 2 diabetes mellitus caused by dapagliflozin,and to provide reference for rational clinical drug use.Methods Totally 21 patients with type 2 diabetes who developed ketosis after taking dapagliflozin in the Department of Endocrinology in our hospital from November 2019 to September 2020 were collected.The clinical data and treatment outcome of the patients were statistically analyzed.Results Among the 21 patients (11 males and 10 females);9 had diabetes course of more than 10 years;HbA1c in 15 patients was higher than 9%;and 6 patients had poor islet function.The patients used more hypoglycemic drugs in combination with acarbose,metformin and liraglutide injection.Potential risk factors for ketosis included irregular diet,emotional anxiety,discontinuation or significant reduction in insulin doses.Ketosis occurred within 1~7 days after the dapagliflozin administration.The clinical manifestations of ketosis mainly covered gastrointestinal reactions such as nausea and vomiting,and a few accompanied by malaise and fatigue.The mean blood glucose in ketosis was 6.8 mmol·L^-1 and the highest related 10.7 mmol·L^-1.Blood gas analysis indicated that ketoacidosis occurred in 4 patients.After discontinuation of dapagliflozin,rehydration,and intravenous infusion of low-dose insulin,the symptoms were all improved,and the ketone body turned negative within 1~4 days.Conclusion Patients with type 2 diabetes may develop ketosis after taking dapagliflozin,especially if the patients have a long course of diabetes and poor islet function,or if they are combined with acarbose,metformin,liraglutide injection and other glucose-lowering drugs that may easily cause gastrointestinal reactions.If patients show non-specific symptoms such as nausea,vomiting,fatigue and malaise after taking dapagliflozin,the ketone body monitoring should be strengthened,and timely treatment measures should be taken when the ketone body is positive to ensure the safety of clinical medi

关 键 词：达格列净 糖尿病酮症 不良反应 

分 类 号：R969.3[医药卫生—药理学]