抗PD-1治疗贲门癌诱发的1例糖尿病酮症的用药分析

报道1例使用ICI治疗晚期贲门癌后出现1型糖尿病(T1DM)的病例.患者为72岁男性,因贲门癌接受抗程序性死亡蛋白1(PD-1)治疗,用药治疗9周后出现口渴、多饮、多尿、乏力、纳差,4周后进展为糖尿病酮症,血糖升高至40.3 mmol·L-1,HbA1C9.4％,空腹及75 g糖负荷后血清C肽均<0.1 ng·mL-1...

Diabetic Ketosis Caused by Anti-PD-1 Therapy in a Patient with Cardia Carcinoma: a Case Report and Literature Review

Here we describe a case of immune checkpoint inhititor (ICI)-associated Type 1 diabetes mellitus (T1DM) in a 72-year-old male patient with advanced cardia carcinoma. He presented with thirsty, polydipsia, polyuria, anepithymia and fatigue 9 weeks after initiation of PD-1 inhibitor. Four weeks later, he developed to diabetic ketosis, with blood glucose up to 40.3 mmol·L-1, HbA1C at 9.4%, serum C peptide under 0.1 ng·mL-1 post fast or 75 g glucose-load and all islet associated antibodies negative. The patient was diagnosed as type 1 diabetes caused by PD-1 inhibitor and received insulin treatment for glycemic control. We also summarize the clinical characteristics, diagnosis and treatment of T1DM caused by PD-1 inhibitor by a comprehensive literature review, to help clinicians recognize ICI-related T1DM earlier.