钠‑葡萄糖共转运蛋白2抑制剂致围术期非高血糖型酮症酸中毒文献病例分析

Literature case analysis of perioperative euglycemic diabetic ketoacidosis induced by sodiumglucose cotransporter 2 inhibitors

目的探讨钠‐葡萄糖共转运蛋白2(SGLT2)抑制剂致糖尿病患者围术期非高血糖型酮症酸中毒(euDKA)的临床特点。方法检索有关数据库,收集截至2019年6月30日收录的SGLT2抑制剂致围术期euDKA的病例报告并提取患者以下信息:人口学特征,糖尿病分型,SGLT2抑制剂使用情况,euDKA发生时间和临床表现,诊断euDKA时血糖、pH、碳酸氢根、阴离子间隙、血β-羟丁酸和尿酮体水平,euDKA诱发因素,以及治疗与转归情况。采用描述性方法分析SGLT2抑制剂致围术期euDKA的临床特点。结果共收集到患者27例(来自20篇文献),男性13例,女性14例;年龄(58±12)岁;2型糖尿病26例,1型糖尿病1例;使用卡格列净者15例,达格列净6例,恩格列净6例;发生euDKA的时间为术后10 h至10 d,其中21例(77.8%)发生在术后3 d内;24例出现与一般酮症酸中毒类似的症状,3例无明显症状;诊断euDKA时血糖水平为(9.5±2.2)mmol/L,其他实验室检查结果与一般酮症酸中毒类似。诱发euDKA的主要因素为手术和低碳水化合物饮食。发生euDKA后所有患者均接受胰岛素和补液治疗,26例(96.3%)好转,1例(3.7%)死亡。结论SGLT2抑制剂致围术期euDKA多发生在术后3 d内;诱发euDKA的因素主要为手术和低碳水化合物饮食;经胰岛素和补液治疗,多数患者预后良好。

Objective To explore the clinical characteristics of perioperative euglycemic diabetic ketoacidosis(euDKA)induced by sodium‐glucose cotransporter 2(SGLT2)inhibitors.Methods The case reports of perioperative euDKA caused by SGLT2 inhibitors published up to June 30,2019 were collected by searching the relevant databases and the following information of patients including demographic characteristics,types of diabetes,use of SGLT2 inhibitors,onset time and clinical manifestation of euDKA,the blood glucose and pH,serum bicarbonate and anion gap,β-hydroxybutyric acid and ketone body concentration in urine when diagnosing euDKA,predisposing factors of euDKA,as well as the treatments and outcomes were collected.The clinical characteristics of perioperative euDKA induced by SGLT2 inhibitors were analyzed descriptively.Results A total of 27 patients(from 20 articles)were collected,including 13 males and 14 females with an age of(58±12)years;26 patients were with type 2 diabetes mellitus and 1 with type 1 diabetes mellitus.Of them,15 cases were treated with canagliflozin,6 cases were treated with dapagliflozin,and 6 cases were treated with empagliflozin;the onset time of euDKA was 10 hours to 10 days after operation and within 3 days after operation in 21 cases(77.8%);24 cases had similar symptoms as ketoacidosis and 3 cases had no obvious symptoms;the blood glucose was(9.5±2.2)mmol/L when diagnosing euDKA and the other laboratory test results were similar to those of ketoacidosis.The main factors inducing euDKA were operation and low carbohydrate diet.After the occurrence of euDKA,all patients received insulin and rehydration therapy,and then 26 cases(96.3%)got better and 1(3.7%)died.Conclusions The perioperative euDKA mainly occurred within 3 days after operation.The main inducing factors of euDKA were operation and low carbohydrate diet.After insulin and rehydration therapy,most patients had a good prognosis.