4例儿童肝移植术后糖尿病的诊治与药学监护  

Diagnosis,Treatment and Pharmaceutical Care of Post-Transplantation Diabetes Mellitus in 4 Children

作　　者：王维娜[1] 侯文婧 何超然 Wang Weina;Hou Wenjing;He Chaoran(Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院,北京100050

出　　处：《儿科药学杂志》2024年第7期15-18,共4页Journal of Pediatric Pharmacy

摘　　要：目的:探讨儿童肝移植受者移植后糖尿病(PTDM)的诊治和药学监护要点。方法:回顾性分析首都医科大学附属北京友谊医院2014-2022年4例儿童肝移植受者PTDM的临床资料,总结临床特点和治疗过程。结果:4例受者肝移植术后均使用以他克莫司为基础的免疫抑制方案,确诊PTDM中位年龄15.5(14.0~17.0)岁,确诊PTDM中位时间为肝移植术后60.5(7.0~81.0)月,确诊后3例将他克莫司转换为环孢素,1例因不耐受环孢素而又转换为他克莫司。根据患儿情况选用胰岛素、二甲双胍和阿卡波糖治疗。中位随访时间10.5(3.0~30.0)月,仅1例完全停用降糖药;4例血糖控制良好,肝功能平稳。结论:儿童PTDM的治疗需综合考虑患儿个体情况和药物因素等,制定个体化治疗方案。可根据情况将他克莫司转换为环孢素,选用胰岛素、二甲双胍等降糖药物,并加强药学监护。Objective:To probe into the diagnosis,treatment and pharmaceutical care of post-transplantation diabetes mellitus(PTDM)in pediatric liver transplant recipients.Methods:Clinical data of PTDM in 4 pediatric liver transplant recipients in Beijing Friendship Hospital,Capital Medical University from 2014 to 2022 were retrospectively analyzed,and the clinical characteristics and treatment process were summarized.Results:All 4 recipients received tacrolimus-based immunosuppressive regimen after liver transplantation.The median age of diagnosis of PTDM was 15.5(from 14.0 to 17.0)years,and the median time of diagnosis of PTDM was 60.5(from 7.0 to 81.0)months after liver transplantation.Three cases were converted from tacrolimus to cyclosporine after diagnosis and one case was converted to tacrolimus due to intolerance of cyclosporine.Medications such as insulin,metformin and acarbose were used individually.The median follow-up time was 10.5(from 3.0 to 30.0)months,only one case completely discontinued hypoglycemic drugs.Blood glucose was well controlled and liver function was stable in 4 recipients.Conclusion:For the treatment of PTDM in children,individual conditions and drug factors should be considered comprehensively to develop an individualized treatment regimen.Tacrolimus can be converted to cyclosporine according to the situation,hypoglycemic treatment such as insulin and metformin can be selected,and pharmaceutical care should be strengthened.

关 键 词：肝移植 移植后糖尿病 儿童 药学监护 

分 类 号：R725.8[医药卫生—儿科]