胰高血糖素样肽1受体激动剂致2型糖尿病患者胰腺损伤的研究进展  

Research progress on pancreatic injury induced by glucagon-like peptide-1 receptor agonists in patients with type 2 diabetes mellitus

作　　者：蒋伟豪 边原[2] 龙恩武 Jiang Weihao;Bian Yuan;Long Enwu(School of Pharmacy,Southwest Medical University,Sichuan Province,Luzhou 646000,China;Department of Pharmacy,Sichuan Academy of Medical Sciences&Sichuan Provincial People′s Hospital,Chengdu 610072,China)

机构地区：[1]西南医科大学药学院,泸州646000 [2]四川省医学科学院·四川省人民医院药学部,成都610072

出　　处：《药物不良反应杂志》2024年第12期749-755,共7页Adverse Drug Reactions Journal

基　　金：国家基础加强计划重点基础研究项目(2023-JCJQ-ZD-118-00)。

摘　　要：胰高血糖素样肽1受体激动剂(GLP-1RA)通过增强胰岛素分泌,抑制胰高糖素分泌,用于治疗2型糖尿病(T2DM)。GLP-1RA疗效和安全性良好,但可能存在胰腺损伤的风险,其发生率较低,但危害较大。目前对GLP-1RA胰腺损伤的研究结论尚不一致。本文从发生情况、可能机制、相关临床研究、临床表现和管理措施几个方面对GLP-1RA相关胰腺损伤研究进展进行了综述。其可能发生机制包括激活星状细胞、诱导胰腺导管上皮细胞增生和化生、存在免疫排斥反应、影响胰腺损伤相关基因的表达等。GLP-1RA相关胰腺损伤中胰腺炎较为常见,临床表现为腹痛、恶心、呕吐,并伴有脂肪酶和淀粉酶的升高。建议临床在用药前对患者进行必要的用药宣教,一旦出现相关症状应考虑可能发生急性胰腺炎,并立即停药。如确诊为胰腺炎,不建议再使用GLP-1RA治疗。Glucagon-like peptide-1 receptor agonists(GLP-1RA)are used to treat type 2 diabetes mellitus(T2DM)by enhancing insulin secretion and inhibiting glucagon secretion.GLP-1RA has good efficacy and safety,but it may have the risk of pancreatic injury.Its incidence is low,but it is more harmful.At present,the research conclusions of GLP-1RA-related pancreatic injury are not consistent.This article reviews the research progress of GLP-1RA-related pancreatic injury from the aspects of occurrence,possible mechanism,related clinical research,clinical manifestations,and management measures.The possible mechanisms include activation of stellate cells,induction of proliferation and metaplasia of pancreatic ductal epithelial cells,presence of immune rejection,and influence on the expression of pancreatic injury related genes.Pancreatitis is more common in GLP-1RA-related pancreatic injury,and its clinical manifestations are abdominal pain,nausea,vomiting,and the elevation of lipase and amylase.It is suggested that patients should be given necessary medication education before medication.Once relevant symptoms occur,acute pancreatitis should be considered and the medication should be stopped immediately.If pancreatitis is confirmed,GLP-1RA treatment is not recommended.

关 键 词：胰高血糖素样肽1受体激动剂 糖尿病 2型 药物相关副作用和不良反应 胰腺损伤 

分 类 号：R587.2[医药卫生—内分泌] R977.15[医药卫生—内科学]