2型糖尿病患者加用吡格列酮出现水肿的初步调查研究

Preliminary investigation of oedema in type 2 diabetic patients following the addition of pioglitazone

目的:调查2型糖尿病患者加用吡格列酮所致水肿的临床特点及肝肾功能和促甲状腺激素水平的变化。方法:2008年1月至12月期间8例服用降糖药加吡格列酮治疗的2型糖尿病患者纳入回顾性调查研究。8例患者中男2例,女6例,年龄52～68岁,平均(58.62±5.65)岁。所有患者均服用2种以上降糖药(二甲双胍、格列喹酮、那格列奈、胰岛素、瑞格列奈、阿卡波糖),并加用吡格列酮15～30 mg/d。调查患者加用吡格列酮后水肿出现和消退时间及其临床特点。于吡格列酮服用前、服用期间及水肿消退后2周进行尿常规和肝、肾功能检查;并于水肿发生时和水肿消退后2周测定促甲状腺激素(TSH)水平。结果:所有患者在服用吡格列酮5～10 d发生水肿,其临床特点为双足和双侧小腿呈指压凹陷性水肿,停药2～7 d水肿消退。吡格列酮服用前,服用期间及水肿消退后2周实验室检查示:尿蛋白均为阴性;血清尿素中位数分别为6.20 mmol/L、6.36mmol/L和5.90 mmol/L;SCr中位数分别为83.5μmol/L、87.0μmol/L和78.0μmol/L;ALT中位数分别为31.5 U/L、32.0 U/L和33.0 U/L;在水肿发生时与水肿消退后2周,TSH中位数分别为7.1 mU/L和6.9 mU/L。结论:服用降糖药的2型糖尿病患者加用吡格列酮可出现双足和双侧小腿指压凹陷性水肿,但对肝、肾功能和促甲状腺激素水平无影响,水肿在停药后迅速消退。

Objective： To investigate the clinical features of oedema and the changes in liver and renal function and thyrotropin level in type 2 diabetic patients following the addition of pioglitazone. Methods：Eight type 2 diabetic patients receiving hypoglyeemic agents plus pioglitazone from January to December in 2008 were enrolled in the retrospective investigation. The 8 patients comprised 2 men and 6 women with age of 52-68 years [ average age （58.62 ± 5.65 ） years ]. All patients received more than 2 hypoglyeemic agents （metformin, gliquidone, nateglinide, insulin, repaglinide, and acarbose） , followed by pioglitazone 15-30 mg daily. The time of oedema onset and disappearance and its clinical features were investigated in patients following the addition of pioglitazone. Before and during pioglitazone administration and 2 weeks after oedema disappearance, the urinary analysis, liver and renal function tests were performed. In addition, the TSH level was measured after oedema onset and 2 weeks after oedema disappearance. Results ： All patients developed oedema 5-10 days after pioglitazone start, and its features were bilateral pitting oedema in both feet and legs. The oedema subsided 2-7 days after pioglitazone withdrawal. The laboratory tests before and during pioglitazone administration and 2 weeks after oedema disappearance revealed that urinary protein was negative; the median serum urea level was 6.20 mmol/L, 6.36 mmol/L, and 5.90 mmol/L, respectively ; the median SCr level was 83.5 μmol/L, 87.0 μmol/L, and 78.0 μmol/L, respectively ; the median ALT level was 31.5 U /L, 32.0 U /L, and 33.0 U /L, respectively. The TSH level after oedema onset and 2 weeks after oedema disappearance was 7.1 mU/L and 6.9 mU/L, respectively. Conclusion ： Type 2 diabetic patients receiving hypoglyeemic agents may develop pitting oedema in both feet and legs following the addition of pioglitazone, but there is no effect on liver and renal function and thyrotropin level, and oedema rapidly resolved after pioglitazone discontinuation.