关注钠-葡萄糖转运蛋白2抑制剂引起的非高血糖性酮症酸中毒  

Pay attention to euglycemic diabetic ketoacidosis caused by sodium-glucose transporter 2 inhibitor

作　　者：纪立伟[1] Ji Liwei(Department of Pharmacy,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing Key Laboratory of Assessment for Clinical Risk and Individual Application of Drugs,Beijing 100730,China)

机构地区：[1]北京医院药学部/国家老年医学中心/中国医学科学院老年医学研究院/药物临床风险与个体化应用评价北京市重点实验室,北京100730

出　　处：《药物不良反应杂志》2021年第6期281-284,共4页Adverse Drug Reactions Journal

基　　金：北京市科技计划课题(D181100000218003)。

摘　　要：钠-葡萄糖转运蛋白2抑制剂(SGLT2i)是新型的口服降糖药,通过抑制肾脏近曲小管对葡萄糖的重吸收、增加尿中葡萄糖排泄而降低血糖。SGLT2i治疗糖尿病疗效确切,但也存在一些安全性问题,其中糖尿病酮症酸中毒(DKA)属于该类药物的严重不良反应。SGLT2i可使2型糖尿病患者DKA的发生风险增加至少7倍,其中约70%为非高血糖性酮症酸中毒(euDKA)。euDKA的风险因素包括胰岛素分泌细胞储备不足、1型糖尿病、胰岛素减量或停用、血容量减少、围手术期、减肥和进食限制等。由于euDKA患者血糖升高不明显,常延误诊断,应高度关注。临床应加强SGLT2i的安全性培训,提高对SGLT2i相关euDKA的认识,严格掌握适应证,避免euDKA的诱因;一旦发生euDKA,能做到早诊断、早治疗。药师应参与SGLT2i的安全管理,提高患者治疗的安全性。Sodium-glucose transporter 2 inhibitors(SGLT2i)are novel oral hypoglycemic agents,which reduces blood glucose by inhibiting the reabsorption of glucose in the proximal convoluted tubule of the kidney and increasing the excretion of glucose to the urine.SGLT2i is effective in the treatment for diabetes mellitus,but there are also some safety problems.Diabetic ketoacidosis(DKA)is a serious adverse reaction of SGLT2i.SGLT2i could cause at least a 7-fold increase in developing DKA,approximately 70%of which are euglycemic DKA(euDKA).The risk factors for euDKA include insufficient insulin secretion cell reserve,type 1 diabetes mellitus,insulin reduction or discontinuation,hypovolemia,perioperative period,weight loss,and restricted feeding,etc.Because the increase of blood glucose in patients with euDKA is not obvious,the diagnosis is often delayed,so close attention should be paid to it.Safety medication training for SGLT2i should be strengthened to improve clinicians′understanding of SGLT2i-related euDKA,so that they can strictly grasp the indications of medication and avoid the inducement of euDKA.Once euDKA occurs,clinicians can make early diagnosis and treatment.Pharmacists should be involved in the safety management of patients using SGLT2i to improve the safety in treatment.

关 键 词：钠-葡萄糖转运蛋白2抑制剂 糖尿病酮症酸中毒 药物相关副作用和不良反应 安全管理 药剂师 

分 类 号：R969.3[医药卫生—药理学]