二肽基肽酶Ⅳ抑制剂与急性胰腺炎

Dipeptidyl-peptidase Ⅳ inhibitors and acute pancreatitis

二肽基肽酶IV（DPP-4）抑制剂是新型口服降糖药物，该类药物能有效降低糖化血红蛋白，耐受性与安全性较好，急性胰腺炎是其少见而严重的不良反应。DPP-4抑制剂致急性胰腺炎潜伏期为14～515d，临床表现为上腹部疼痛，实验室检查可见血清淀粉酶、脂肪酶和弹性蛋白酶水平显著升高。病理学检查可见胰腺和胰周组织水肿和坏死。DPP-4抑制剂致急性胰腺炎的机制主要涉及变态反应和药物或代谢产物对胰腺的直接毒性。有胰腺炎病史者应慎用DPP-4抑制剂。密切注意患者用药情况并监测血清淀粉酶、脂肪酶和弹性蛋白酶水平，是预防DPP-4抑制剂致急性胰腺炎发生和发展的有效措施。

Dipeptidyl-peptidase IV （DPP-4） inhibitors are a new class of oral hypoglycemic drugs. These drugs can effectively reduce glycated hemoglobin, as well as have a good tolerability and safety. Acute pancreatitis is a rare, but serious adverse reaction of DPP4 inhibitors. The latent period of DPP-4 inhibitor induced acute pancreatitis is from 14 to 515 days. The symptom includes abdominal pain, and laboratory examination showed that serum amylase, lipase and elastase levels are markedly elevated. The pathological examination showed diffuse edema and necrosis of pancreas and peripancreatic tissue. The mechanism of DPP-4 inhibitors induced acute pancreatitis mainly relates to the allergy and direct toxicity of the drugs or metabolite to pancreas. DPP-4 inhibitor should be used with caution in patients with a history of pancreatitis. Closely monitoring the clinical presentations and the levels of serum amylase, lipase and elastase during treatment with DPP-4 inhibitors is the effective measure to prevent the occurrence and development of acute