他克莫司引起继发性糖尿病的临床转归和药学监护

目的:对2例他克莫司(FK506)引起的继发性糖尿病(PTDM)患者进行随访并总结此类患者药学监护要点。方法:检索近年来国内外PTDM相关文献,指导患者正确使用降糖药物,进行规律血糖监测并复查糖代谢相关指标。结果:PTDM的发生机制类似于2型糖尿病,但其具有显著特点:发生PTDM多于移植后30～60d;随着移植时间的延长,胰岛素用量会较前显著减少,甚至停用;降糖策略应以胰岛素治疗为主。2例患者血糖水平较PTDM诊断初期均明显改善,降糖药物剂量明显减少。第1例患者在治疗过程中未发生严重低血糖,并在1年后PTDM临床缓解,血清C肽检查示胰岛细胞功能恢复良好;第2例患者发生PTDM后饮食控制不严格,血糖控制不达标,目前仍使用胰岛素控制血糖。结论:应重视他克莫司引起的PTDM,正确认识PTDM并指导患者规律监测血糖和合理使用降糖药物,防止发生低血糖。

Pharmaceutical care and turnover of secondary diabetes induced by tacrolimus

Objective：To summary the key points of pharmaceutical care for posttransplant diabetes mellitus（PTDM） patients with 1-year following up.Methods：Literatures concerning PTDM published in domestic and international journals were reviewed.The patients were instructed to use drugs correctly,self-monitor blood glucose and recheck glucose metabolism index.Results：The mechanism of PTDM was similar to that of type 2 diabetes.But the characteristics of PTDM were that it started at 30 –60 days after transplantation,insulin dosage was reduced or stopped during the treatment according to the serum glucose level,the regimens had to be administered with insulin in PTDM patients.Both patients＇ blood glucose were improved than that in the beginning of diagnosis and the dosage of insulin was decreased obviously.The first patient was cured 1-year later without severe hypoglycemia and the C peptide test showed the function of islet cell recovered.The second patient did not control his diet and his glucose level was still higher than the criterion.He was still treated with insulin.Conclusion：PTDM induced by tacrolimus should be paid attention to.Clinical pharmacist could help patients to know PTDM,instruct the patient to monitor serum glucose regularly and use drugs correctly to prevent the hypoglycemia.