纳武利尤单抗致暴发性1型糖尿病

Fulminant type 1 diabetes mellitus caused by nivolumab

1例82岁女性患者因右肺上叶中心性腺癌多发转移接受纳武利尤单抗单药治疗(240 mg静脉滴注、第1天,14 d为1个周期)。免疫治疗8个周期(约4个月)后,患者出现严重恶心、呕吐。实验室检查:随机血糖43.2 mmol/L,β-羟丁酸5.3 mmol/L;血气分析结果示pH 7.01,碳酸氢根4.0 mmol/L,碱剩余-22.4 mmol/L,血钾6.1 mmol/L,乳酸2.9 mmol/L。患者既往无糖尿病病史,考虑为纳武利尤单抗所致暴发性1型糖尿病。停用纳武利尤单抗,给予补液、降糖、纠正酸中毒及对症治疗。2 d后患者症状明显改善,实验室检查:空腹血糖15.8 mmol/L,β-羟丁酸0.2 mmol/L;血气分析结果示pH 7.39,碳酸氢根21.2 mmol/L,碱剩余-3.8 mmol/L,血钾4.3 mmol/L,乳酸1.0 mmol/L。

An 82-year-old female patient received monotherapy with nivolumab(240 mg by an IV infusion on the firsr day,14 days as a cycle)because of multiple metastases of central adenocarcinoma in the right upper lobe of the lung.After 8 cycles of immunotherapy(about 4 months),the patient developed severe nausea and vomiting.Laboratory tests showed random blood glucose 43.2 mmol/L andβ-hydroxybutyric acid 5.3 mmol/L.Blood gas analysis showed pH 7.01,bicarbonate root 4.0 mmol/L,alkali residual-22.4 mmol/L,serum potassium 6.1 mmol/L,and lactic acid 2.9 mmol/L.The patient had no previous history of diabetes mellitus.Fulminant type 1 diabetes mellitus due to nivolimab was considered.Nivolumab was stopped and rehydration,hypoglycemia,acidosis correction,and other symptomatic treatments were given.Two days later,her symptoms were improved obviously.Laboratory tests showed fasting plasma glucose 15.8 mmol/L andβ-hydroxybutyric acid 0.2 mmol/L.Blood gas analysis showed pH 7.39,bicarbonate root 21.2 mmol/L,alkali residual-3.8 mmol/L,serum potassium 4.3 mmol/L,and lactic acid 1.0 mmol/L.