替雷利珠单抗致暴发性1型糖尿病

Fulminant type 1 diabetes mellitus caused by tirelizumab

1例73岁男性淋巴结转移性肉瘤样癌患者接受替雷利珠单抗注射液200 mg静脉滴注、第1天,21 d为1个治疗周期。第10个周期治疗后患者出现头晕、胸闷、恶心、呕吐,实验室检查:随机血糖99.1 mmol/L,血清肌酐(Scr)260μmo/L,血钾5.8 mmo/L,血钠129 mmol/L,血渗透压368 mOsm/(kg·H2O),血气分析示pH 7.1,乳酸2.8 mmol/L。考虑为酮症酸中毒。给予补液、胰岛素降糖和补充电解质等治疗。5 d后患者症状好转,实验室检查示血钾4.4 mmol/L,血钠134 mmol/L,二氧化碳结合力17.0 mmol/L,空腹C肽0.02 nmmol/L。7 d后实验室检查示空腹C肽0,餐后2 h C肽0,诊断为暴发性1型糖尿病,考虑与替雷利珠单抗有关。19 d后患者空腹血糖5.8 mmol/L,餐后2 h血糖19 mmol/L,Scr 102μmol/L,血钠139 mmol/L,血氯108 mmol/L,血钾3.9 mmol/L。

A 73-year-old male patient with metastatic sarcomatoid carcinoma of lymph node received an IV infusion of tirelizumab 200 mg on day 1,and 3 weeks was 1 cycle.After 10 cycles of treatment,the patient developed dizziness,chest tightness,nausea,and vomiting.Laboratory tasts showed random blood glucose 99.1 mmol/L,serum creatinine(Scr)260μmo/L,blood potassium 5.8 mmo/L,blood sodium 129 mmol/L,and blood osmotic pressure 368 mOsm/(kg·H2O).Blood gas analysis showed pH 7.1 and lactic acid 2.8 mmol/L.Ketoacidosis was considered and treatments such as rehydration,hypoglycemic with insulin,and electrolyte supplement were given.After 5 days of treatments,the patient′s symptoms were improved,and laboratory tests showed blood potassium 4.4 mmol/L,blood sodium 134 mmol/L,carbon dioxide binding capacity 17.0 mmol/L,and fasting C-peptide 0.02 nmol/L.Seven days later,laboratory tests showed fasting C-peptide 0 and 2 h post-prandial C-peptide 0.The patient was diagnosed with fulminant type 1 diabetes mellitus,which was considered to be related to tirelizumab.After 19 days of treatments,laboratory tests showed fasting blood glucose 5.8 mmol/L,blood glucose at 2 hours after meal 19 mmol/L,Scr 102μmol/L,blood sodium 139 mmol/L,blood chlorine 108 mmol/L,and blood potassium 3.9 mmol/L.