纳武利尤单抗致Ⅰ型糖尿病文献病例分析

Cases Analysis of Type 1 Diabetes Mellitus Induced by Nivolumab

关键词:  纳武利尤单抗  Ⅰ型糖尿病  文献病例分析  酮症酸中毒

Key words:  nivolumab  type 1 diabetes mellitus  analysis of literature  ketoacidosis

摘要:

目的 分析纳武利尤单抗致Ⅰ型糖尿病的临床特点。方法 通过检索中国知网、维普、万方、PubMed、Web of Science和MEDLINE数据库，共收集截至2019年9月纳武利尤单抗致Ⅰ型糖尿病的个案报道30例进行分析。结果 30例病例中，暴发性I型糖尿病患者16例；出现酮症酸中毒患者18例。Ⅰ型糖尿病中位发生时间为87.5（37.5，241.5） d，血糖从正常至异常的中位间隔时间为2（2，4）周，临床症状主要以多尿多饮（17例次，28.33%），不同程度的疲劳（14例次，23.33%），恶心/呕吐（11例次，18.33%）为主。27例患者经胰岛素治疗后血糖控制可； 16例重启了纳武利尤单抗治疗。结论 纳武利尤单抗致Ⅰ型糖尿病具有潜伏期分散、并发酮症酸中毒较高、血糖控制佳时纳武利尤单抗方案可重启的特点。临床在应用纳武利尤单抗过程中需常规密切监测患者血糖。

Abstract:

OBJECTIVE To analyze the clinical features of type 1 diabetes mellitus induced by nivolumab. METHODS Thirty cases of nivolumab-induced type 1 diabetes mellitus published before September 2019 were collected by retrieving PubMed, Web of Science, MEDLINE, CNKI, VIP and WangFang database, and then the data were analyzed statistically. RESULTS In the 30 cases, 16 cases were classified with fulminant type 1 diabetes mellitus and 18 cases developed ketoacidosis. The median occurrence time of nivolumab-induced type 1 diabetes mellitus was 87.5(37.5, 241.5)d, while the median interval of blood glucose change from normal to abnormal was 2(2, 4) weeks, the mainly clinical symptoms were polyuria and polydipsia(17 cases, 28.33%), different degrees of fatigue(14 cases, 23.33%), and nausea/vomiting(11 cases, 18.33%). The 27 patients were able to control their blood glucose after insulin therapy and 16 patients restarted nivolumab therapy. CONCLUSION Type 1 diabetes mellitus induced by nivolumab has the characteristics of dispersed incubation period, high complicated with ketoacidosis, and nivolumab can be restarted by actively blood glucose controlling. It is necessary to closely monitor patients' blood glucose routinely in the clinical application of nivolumab.