恶性肿瘤免疫治疗相关性低血糖反应三例治疗失误分析

Analysis of Unsuccessful Treatments in Three Patients with Malignant Tumor Immunotherapy-related Hypoglycemia

目的分析恶性肿瘤免疫治疗相关性低血糖反应3例的治疗失误原因、防范措施及规范疗法。方法对2018年1月—2021年1月恶性肿瘤患者应用免疫治疗后出现低血糖反应3例的临床资料进行回顾性分析。结果3例恶性肿瘤分别应用程序性细胞死亡蛋白-1抑制剂过程中或治疗后出现心悸、大汗淋漓等症状,查血糖水平降低,补充高浓度葡萄糖后好转,但症状反复。排除其他常见成人低血糖病因后,均确诊为免疫治疗相关性低血糖反应。3例应用糖皮质激素治疗后,均未再出现低血糖反应。结论低血糖反应是恶性肿瘤免疫治疗后较为罕见的不良反应,临床医生需加强对该病的认识,明确病因,及时应用糖皮质激素治疗。

Objective To analyze causes of unsuccessful treatments,preventive measures and standardized treatments in three patients with malignant tumor immunotherapy-related hypoglycemia.Methods Clinical data of 3 patients with malignant tumors who had experienced hypoglycemia after immunotherapy between January 2018 and January 2021 was retrospectively analyzed.Results Three malignant tumors patients with symptoms such as palpitations and sweating during or after the treatment with programmed cell death protein-1 inhibitors.Blood glucose levels were decreased,and the symptoms were improved after supplementation with high-concentration glucose,but then the symptoms repeated.After excluding other common causes of adult hypoglycemia,all patients were confirmed as having immunotherapy-related hypoglycemia.All the 3 patients were treated with glucocorticoids,and none of them had recurred hypoglycemia.Conclusion Hypoglycemia is a rare adverse event in patients with malignant tumors after immunotherapy.Clinicians need to strengthen their understanding of the disease,identify the cause and apply glucocorticoid therapy in time.