徐惟捷.钠-葡萄糖共转运蛋白2抑制剂相关性糖尿病酮症酸中毒[J].内科急危重症杂志,2022,28(4):269-271
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| DOI：10.11768/nkjwzzzz20220402 |
| 中文关键词: 钠-葡萄糖转运蛋白2抑制剂 酮症酸中毒 正常血糖性酮症酸中毒 |
| 英文关键词: |
| 基金项目:国家自然科学基金（No：81974109） |
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| 中文摘要: |
| 钠-葡萄糖转运蛋白2抑制剂(SGLT2i）是一种通过增加尿糖排泄来降低血糖的新型口服降糖药，因具有心肾保护作用而广泛地应用于2型糖尿病（T2D）患者。但在临床中发现该类药物可通过多种途径升高血酮体水平，在疾病的急性期、手术、食物和液体摄入减少、脱水、酒精中毒、胰岛素用量骤减等情况，特别是当胰岛素缺乏和脱水同时出现时，血酮体水平的进一步升高会引起非高血糖性酮症酸中毒（euDKA）。值得注意的是在这类DKA发生时，患者的血糖水平可以正常或轻度升高，而且起病初期临床症状往往不太典型，仅有轻微的头晕、乏力、恶心或只是略感不适，常常会延误诊断。因此，临床医生在给患者使用SGLT2i之前，需要评估患者是否具有发生DKA的高危因素，选择合适的患者使用该药。在用药过程中，定期监测血β-羟丁酸水平，在出现可能导致DKA的诱因时及时停用该药。 |
| 英文摘要: |
| Sodium-glucose transporter 2 inhibitors (SGLT2i) are a novel class of oral hypoglycemic agents that lower blood sugar by increasing urinary glucose excretion. It has been recommended as a second - or third-line therapy for type 2 diabetes (T2D) by domestic and foreign guidelines due to its weight loss and cardiorenal protection. Clinically, it has been found that these agents can increase the level of blood ketone bodies through several pathways. In case of acute phase of diseases, surgery, decreased intake of food and fluids, dehydration, alcoholism, and sudden decrease in insulin consumption, especially when insulin deficiency and dehydration occur at the same time, the level of blood ketone bodies will further increase, which can lead to euglycemic diabetic ketoacidosis (euDKA). When this type of DKA occurs, the blood glucose of the patient is normal or slightly elevated, and the initial clinical symptoms are not typical, with only slight dizziness, fatigue, nausea or only slight discomfort, which leads to delayed diagnosis. Therefore, clinicians need to evaluate whether patients have high risk factors for DKA before administering SGLT2i, and select appropriate patients to use the agent. Blood β-hydroxybutyric acid level should be monitored regularly when patients are on SGLT2i therapy, and the agent should be stopped in time when there are triggers which may lead to DKA. In addition, when patients have unexplained metabolic acidosis but with normal or slightly higher blood glucose levels during the acute phase of disease, surgery, reduced food and fluid intake, dehydration, alcoholism, and sudden reduction of insulin use, it is necessary to check medication history and consider the possibility of euDKA due to SGLT2i. |
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