免疫检查点抑制剂相关糖尿病2例报道及文献回顾  

Immune Checkpoint Inhibitors Related Diabetes Mellitus:A Report of 2 Cases and Literature Review

作　　者：任尧尧[1] 张琳琳[1] 王瑜[2] 钟殿胜[1] Yaoyao REN;Linlin ZHANG;Yu WANG;Diansheng ZHONG(Department of Oncology,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Endocrinology,Tianjin Medical University General Hospital,Tianjin 300052,China)

机构地区：[1]天津医科大学总医院肿瘤科,天津300052 [2]天津医科大学总医院内分泌科,天津300052

出　　处：《中国肺癌杂志》2022年第1期61-65,共5页Chinese Journal of Lung Cancer

摘　　要：免疫检查点抑制剂在临床应用日益广泛,少见不良反应的发生日益增多。本文的目的是进一步提高对免疫检查点抑制剂相关糖尿病的认识。我们报道2例免疫检查点抑制剂相关糖尿病病例。对免疫检查点抑制剂相关糖尿病进行文献复习,讨论相关临床特点、可能的机制及最佳治疗方式。2例患者均为老年女性,1例在使用程序性死亡受体-配体1(programmed cell death-Ligand 1,PD-L1)单抗7个月后出现血糖增高,1例在使用PD-1单抗6周后出现糖尿病酮症酸中毒。2例患者诊断明确后均使用外源性胰岛素控制血糖。病例1持续使用免疫检查点抑制剂至今,病例2未再接受免疫治疗。人类白细胞抗原(human leukocyte antigen,HLA)基因型等因素可能解释了某些个体出现免疫检查点抑制剂相关糖尿病的危险原因。免疫检查点抑制剂相关糖尿病是一种并不少见,但可以危及生命的内分泌系统不良反应,需要医生提高警惕。使用免疫检查点抑制剂的患者需要进行血糖监测,如果出现血糖异常应及时请内分泌专科医生协助诊治。Immune checkpoint inhibitors(ICIs)are widely used in clinic,and the incidence of rare adverse events are increasing.The aim of this paper is to better define the rare adverse effect of diabetes mellitus associated with ICIs.We report 2 cases of diabetes mellitus associated with ICIs.Literature review was conducted and we discussed the clinical presentation,potential mechanisms and suggestions for optimal management.Two patients were both elderly women,case 1 had increased blood glucose after 7 months of using Durvalumab,and cases 2 had diabetic ketoacidosis after 6 weeks of using Pembrolizumab.Both patients were administered exogenous insulin to control blood glucose.Case 1 has been treated with Durvalumab until now and case 2 dis continued using of Pembrolizumab.HLA genotypes and other factors may explain the risk factors of diabetes associated with ICIs in some individuals.Diabetes mellitus associated with ICIs is an uncommon but potentially life-threatening endocrine system adverse event,which requires doctors to be vigilant.The patients who use ICIs need to monitor blood glucose.If they have hyperglycemia,endocrinologists should be asked to assist in diagnosis and treatment.

关 键 词：肺肿瘤 免疫检查点抑制剂 糖尿病 

分 类 号：R979.1[医药卫生—药品] R587.1[医药卫生—药学]