达格列净致正常血糖酮症酸中毒文献分析

Literature Analysis of Dapagliflozin-induced Euglycemic Diabetic Ketoacidosis

目的探究达格列净致正常血糖酮症酸中毒的临床特征,为临床安全合理使用达格列净提供参考。方法检索中国知网、万方数据、维普网、Pubmed和Embase数据库,检索时间截至2019年6月30日发表的使用达格列净出现正常血糖酮症酸中毒的文献,对文献中患者的一般情况、药物使用情况、就诊治疗情况、危险因素、转归及关联性评价等进行统计分析。结果共纳入29篇文献,41例病例。男性13例,女性28例,平均年龄(52.15±15.32)岁。50.00%的不良反应发生在用药后1个月内。最常出现的临床症状包括呕吐、恶心、腹痛、呼吸困难、虚弱等。患者确诊时平均血糖10.13 mmol/L,pH 7.15,血碳酸氢根8.65 mmol/L,阴离子间隙25.05 mmol/L,β-羟丁酸5.85 mmol/L。最常见的危险因素包括手术、低碳水化合物饮食、感染、胰岛素减量或停用。40例患者经过积极治疗后均好转,1例患者死亡。药品不良反应关联性评价结果均为“很可能”。结论重视达格列净导致正常血糖酮症酸中毒的风险,加强对高风险患者在用药初期的随访监测,对出现酮症酸中毒症状患者应及时诊断和治疗,确保用药安全。

Objective To investigate the characteristics of dapaglif lozin-induced euglycemic diabetic ketoacidosis so as to provide reference for clinical safe and rational use of dapagliflozin.Methods Literature about euglycemic diabetic ketoacidosis induced by dapagliflozin published as of June 2019 was retrieved from CNKI,VIP Chinese full-text database,Wanfang database,Pubmed and Embase.The basic information,drug use,treatment,risk factors,outcomes and relevance evaluation of the cases were statistically analyzed.Results A total of 29 papers involving 41 cases were included.There were 13 males and 28 females with an average age of(52.15±15.32)years old.50.00%of the adverse reactions occurred within one month after medication.The most common clinical symptoms were vomiting,nausea,abdominal pain,dyspnea and weakness.At the time of diagnosis,blood glucose averaged 10.13 mmol/L,pH 7.15,blood bicarbonate 8.65 mmol/L,anion gap 25.05 mmol/L,andβ-hydroxybutyrate 5.85 mmol/L.The most common risk factors included surgery,lowcarbohydrate diets,infections,and insulin reduction or discontinuation.Forty patients recovered after treatment,but one patient died.The results of relevance evaluation were all"very likely".Conclusion We should be alert to the risk of euglycemic diabetic ketoacidosis induced by dapagliflozin,and strengthen the follow-up for highrisk patients in the initial stage of dapagliflozin medication so as to treat patients with symptoms of ketoacidosis as early as possible and ensure the safety of drug use.