利拉鲁肽与恩格列净联用致急性胰腺炎

Acute pancreatitis induced by combined use of liraglutide and empagliflozin

1例26岁男性2型糖尿病患者因胰岛素类药物联合二甲双胍治疗效果欠佳而加用利拉鲁肽(0.6 mg/d),4 d后利拉鲁肽剂量加倍同时加用恩格列净(10 mg口服、1次/d)。次日,患者出现恶心、呕吐和腹痛症状伴血淀粉酶和脂肪酶升高(峰值分别为1048 U/L和26 U/L)。诊断为急性胰腺炎,遂停用所有降血糖药,给予禁食、胃肠减压、静脉补液、小剂量胰岛素持续输注,同时给予兰索拉唑、生长抑素等对症治疗。3 d后患者症状缓解,血淀粉酶和脂肪酶恢复正常。10 d后,改用门冬胰岛素30注射液(早24 U、晚16 U)餐前皮下注射,二甲双胍0.5 g口服、3次/d,血糖得以控制,未再出现胰腺炎症状。考虑患者的胰腺炎可能与利拉鲁肽联合恩格列净治疗有关。

A 26-year-old male patient with type 2 diabetes mellitus was given liraglutide(0.6 mg/d)on the basis of insulin combined with metformin because of the poor therapeutic effect.Four days later,the dose of liraglutide was doubled and empagliflozin(10 mg orally,once daily)was added.The next day,the patient developed nausea,vomiting,and abdominal pain accompanied by elevated serum amylase and lipase(peak levels were 1048 U/L and 26 U/L,respectively).Acute pancreatitis was diagnosed,all hypoglycemic drugs were discontinued,and fasting,gastrointestinal decompression,intravenous fluid infusion,continuous infusion of low-dose insulin,and symptomatic treatments with lansoprazole and somatostatin were given.Three days later,the patient′s symptoms were relieved,and serum amylase and lipase levels returned to normal.Ten days later,the hypoglycemic drug was changed to subcutaneous injection of insulin aspart 30 injection(24 U in the morning and 16 U in the evening)before meals and oral metformin 0.5 g thrice daily.His blood glucose was controlled and no symptoms of pancreatitis recurred.Therefore,it was considered that the patients′pancreatitis might be related to the combined use of liraglutide and empagliflozin.