度拉糖肽致不良反应文献分析

目的:探讨度拉糖肽致不良反应的发生规律和特点，为临床合理用药提供依据。方法:检索截至2021年12月31日国内外数据库关于度拉糖肽致不良反应个案报道文献，进行整理分析。结果:共收集10例不良反应，男性、女性各5例，年龄50～84岁；不良反应多发生于用药后1个月内；10例均为严重药物不良反应，涉及皮肤系统如坏疽性脓皮病、麻疹样药疹、大疱性类天疱疮，消化系统如药物性肝损伤、胆囊炎，血液系统如静脉血栓形成，心血管系统如房颤加重，泌尿系统如急性肾损伤，以及引发内分泌系统的糖尿病酮症酸中毒合并高渗性高血糖状态，经对症治疗后均好转。其中，坏疽性脓皮病、麻疹样药疹、大疱性类天疱疮、药物性肝损伤、静脉血栓形成、糖尿病酮症酸中毒合并高渗性高血糖状态均为说明书中未记载的不良反应。结论:医务工作者应加强对度拉糖肽不良反应的认识，对老年患者、肝肾功能不全、既往存在相关不良反应危险因素以及合并用药如胰岛素的患者在使用度拉糖肽时应加强用药1个月内药学监护，降低严重不良反应的程度。

Literature analysis of adverse drug reactions induced by dulaglutide

OBJECTIVE To explore the general regularity and characteristics of adverse reactions induced by dulaglutide, and to provide reference for rational drug use in clinic. METHODS The case reports of adverse reactions caused by dulaglutide were searched from the domestic and foreign databases up to December 31, 2021, and then analyzed and summarized. RESULTS Totally 10 cases of adverse reactions were collected, involving 5 males and 5 females at the age of 50-84 years old; the adverse reactions mostly occurred within one month after administration; all the 10 cases were serious adverse drug reactions, involving dermal system such as pyoderma gangrenosum, morbilliform drug eruption and bullous pemphigoid, digestive system such as drug-induced liver injury and cholecystitis, blood system such as cerebral venous thrombosis, cardiovascular system such as exacerbation of atrial fibrillation, urinary system such as acute kidney injury, and endocrine system such as a mixed picture of diabetic ketoacidosis and hyperosmolar hyperglycaemic state. All the patients were improved after symptomatic treatment. Among the adverse reactions, pyoderma gangrenosum, morbilliform drug eruption, bullous pemphigoid, drug-induced liver injury, cerebral venous thrombosis, diabetic ketoacidosis combined with hyperosmolar hyperglycemia were all the ones not recorded in the instruction. CONCLUSION Medical workers should enhance awareness of adverse reactions of dulaglutide. For elderly patients, patients with liver and kidney insufficiency, as well as previous risk factors for related adverse reactions, and patients with co-administration of drugs such as insulin, pharmaceutical care should be strengthened within 1 month of medication to reduce the severity of serious adverse reactions.