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目的:探讨卡格列净致正常血糖酮症酸中毒的特点及规律,为临床合理安全使用提供参考。方法:在CNKI、万方、维普、PubMed、Embase数据库中检索自建库截止至2019年6月30日卡格列净致正常血糖酮症酸中毒的文献,对患者的一般情况、药物使用情况、就诊治疗情况、危险因素、转归及关联性评价等进行统计分析。结果:共计纳入49篇文献,患者65例,其中男性26例(40%),女性39例(60%)。药品不良反应(ADR)发生在用药后1个月内占51.35%。ADR以胃肠系统损害(63.64%)为主,常见的临床症状主要包括呕吐、恶心、腹痛等。患者确诊正常血糖酮症酸中毒时平均血糖10.01 mmol·L-1,酮体检测均为阳性。主要危险因素包括手术(35.00%)、胰岛素减量或停用(20.00%)和低碳水化合物饮食(16.67%)。所有患者经过治疗后均好转。不良反应关联性评价结果集中在"很可能"。结论:建议临床应重视卡格列净导致正常血糖酮症酸中毒的风险,加强对高风险患者在用药初期的随访监测,对出现酮症酸中毒症状的患者及时诊断和治疗,确保用药安全。
Abstract：Objective: To investigate the characteristics and regularities of canagliflozin-induced euglycemic diabetic ketoacidosis(euDKA), and provide references for clinical safe and rational use of canagliflozin. Methods: Literature of euDKA induced by canagliflozin published until June 30th 2019 were retrieved from CNKI, Wanfang database, VIP, PubMed and Embase. Data were analyzed statistically in respect of general information, drugs, treatment, risk factors, outcome and relevance evaluation. Results: A total of 49 papers, 65 patients were enrolled. Among them, 26 cases(40%) were males and 39 cases(60%) were females. 51.35% of the adverse drug reaction(ADR) occurred within one month after medication. ADR mainly manifested as gastrointestinal system damage(63.64%) such as vomiting, nausea, abdominal pain, and so on. The average blood glucose of the patients at the time of diagnosis of euDKA was 10.01 mmol·L-1 and the ketone body was positive. The main risk factors of euDKA included surgery(35.00%), insulin reduction or discontinuation(20.00%) and low-carbohydrate diets(16.67%). All patients improved after treatment. Most results of relevance evaluation of ADR were very likely. Conclusion: Measures should be taken to ensure the safety use of canagliflozin including paying attention to the risk of euDKA caused by canagliflozin, strengthening the follow-up monitoring of patients with high risk in the early stage of medication, timely diagnosis and treatment of patients with symptoms of euDKA.
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基本信息:
中图分类号:R969.3
引用信息:
[1]蔡俊,姚瑶,刘梦颖,等.卡格列净致正常血糖酮症酸中毒相关文献分析[J].中国药物应用与监测,2020,17(05):321-324.
基金信息:
江苏省药学会-天晴(连云港)医院药学科研项目(Q2019024);; 南京药学会-常州四药医院药学科研基金项目(2019YX016)
2020-10-25
2020-10-25