甲泼尼龙致重症肌无力患者严重低血糖的病例分析

Case analysis of severe hypoglycemia caused by methylprednisolone

1例50岁男性重症肌无力患者,先后给予溴吡斯的明片改善肌无力症状,甲泼尼龙片、吗替麦考酚酯胶囊抑制免疫,奥美拉唑肠溶片和碳酸钙D_(3)片预防激素相关不良反应等治疗。患者无糖尿病史,入院后测空腹血糖4.92 mmol/L。甲泼尼龙片治疗1周后,空腹血糖降至3.56 mmol/L。甲泼尼龙片治疗11 d后,空腹血糖低至2.80 mmol/L。排除其他药物后,考虑低血糖由甲泼尼龙引起的可能性大。因病情需要,且患者未诉大汗、心悸等低血糖症状,未予停药处理。随访2个月,患者甲泼尼龙逐渐减量,多次复查,血糖逐渐恢复至正常范围。

A 50-year-old male patient with myasthenia gravis was treated with bromopyristine tablets to improve myasthenia symptoms,methylprednisolone tablets and mortemycophenolate capsules to suppress immunity,omeprazole enteric-coated tablets and calcium carbonate D_(3) to prevent hormonal adverse reactions.The patient had no history of diabetes,and the fasting blood glucose was 4.92 mmol/L after admission.After 1 week of treatment with methylprednisolone tablets,fasting blood glucose decreased to 3.56 mmol/L.After treatment with methylprednisolone tablet for 11 days,the fasting blood glucose decreased to 2.80 mmol/L.After excluding other drugs,it was considered that the possibility of hypoglycemia caused by methylprednisolone was high.Considering that the patient's treatment was required by the disease,and no hypoglycemia symptoms such as sweating and palpitation were reported,the drug was not stopped.After 2 months of follow-up,the amount of methylprednisolone for the patient gradually decreased,and the blood glucose of the patient gradually recovered to the reference value range in the following reexaminations.