抗PD-1治疗贲门癌诱发的1例糖尿病酮症的用药分析

Diabetic Ketosis Caused by Anti-PD-1 Therapy in a Patient with Cardia Carcinoma:a Case Report and Literature Review

报道1例使用ICI治疗晚期贲门癌后出现1型糖尿病(T1DM)的病例。患者为72岁男性,因贲门癌接受抗程序性死亡蛋白1(PD-1)治疗,用药治疗9周后出现口渴、多饮、多尿、乏力、纳差,4周后进展为糖尿病酮症,血糖升高至40.3 mmol·L^(-1),HbA1C9.4%,空腹及75 g糖负荷后血清C肽均<0.1 ng·mL^(-1),胰岛相关抗体均阴性,诊断为PD-1抑制剂相关T1DM,予以胰岛素降糖治疗。同时查阅文献,求证循证医学,总结抗PD-1相关T1DM的临床特征、诊断及治疗,以期临床能对该类不良反应作出早期识别。

Here we describe a case of immune checkpoint inhititor(ICI)-associated Type 1 diabetes mellitus(T1DM)in a 72-year-old male patient with advanced cardia carcinoma.He presented with thirsty,polydipsia,polyuria,anepithymia and fatigue 9 weeks after initiation of PD-1 inhibitor.Four weeks later,he developed to diabetic ketosis,with blood glucose up to 40.3 mmol·L^(-1),HbA1C at 9.4%,serum C peptide under 0.1 ng·mL^(-1) post fast or 75 g glucose-load and all islet associated antibodies negative.The patient was diagnosed as type 1 diabetes caused by PD-1 inhibitor and received insulin treatment for glycemic control.We also summarize the clinical characteristics,diagnosis and treatment of T1DM caused by PD-1 inhibitor by a comprehensive literature review,to help clinicians recognize ICI-related T1DM earlier.