关艳春^1,,
唐旖阳²,
马骁³,
方美云^4,5,,
1. 大连医科大学附属第一医院 风湿免疫科，辽宁 大连 116011
2. 大连医科大学附属第一医院 内分泌科，辽宁 大连 116011
3. 大连医科大学附属第一医院 麻醉科，辽宁 大连 116011
4. 大连医科大学附属第一医院 血液科，辽宁 大连 116011
5. 大连大学附属中山医院 血液科，辽宁 大连 116011

基金项目: 国家自然科学基金项目(81370604)


详细信息 作者简介: 关艳春(1986-)，女，主治医师。E-mail：gycgychhh@163.com




通讯作者: 方美云，教授。E-mail：489343758@qq.com 中图分类号: R587.1


摘要:由于强大有效的抗炎和免疫抑制作用，糖皮质激素(glucocorticoids, GCs) 广泛应用于临床，是治疗风湿免疫病和血液系统等疾病的主要药物之一。诱导高血糖及糖尿病是糖皮质激素最常见副作用之一。如处理不及时会导致原发病控制不佳，增加感染风险，导致高渗性昏迷、酮症酸中毒，延长住院时间及增加死亡率等。对于需要接受中高剂量GCs治疗或已有糖尿病危险因素的患者，建议进行血糖筛查及更严格的血糖控制。GCs对葡萄糖代谢的影响复杂，机制尚未完全清楚，目前认为主要通过增加胰岛素抵抗、增加肝糖异生和诱导胰岛β细胞功能障碍，导致血糖升高。治疗方式主要包括应用口服药物及胰岛素治疗。本文对GCs诱导的高血糖及糖尿病相关机制及诊治进展进行综述。
关键词: 糖尿病/
糖皮质激素/
降糖药物/
二肽基肽酶4抑制剂/
胰高血糖素样肽-1受体激动剂/
胰岛素


Abstract:Glucocorticoids are powerful and effective anti-inflammatory and immunosuppressive drugs. They have extensive use in the treatment of different diseases, including autoimmune rheumatic disease and hematological diseases. They can exacerbate hyperglycemia or facilitate the development of metabolic disease, the so-called steroid-induced diabetes mellitus, as one of the common side effects. Unexpected hyperglycemia associated with the initiation of glucocorticoids often leads to poor control of primary disease and increased risks for infection, and causes hyperosmolar coma, ketoacidosis, preventable hospital admissions and prolonged hospital stays. Glucose monitoring and strict glucose control are recommended for patients who require moderate to high doses of glucocorticoids or have existing risk factors for diabetes. The effects of glucocorticoids on glucose metabolism are complex and the mechanisms are not fully understood. It is mainly through increasing insulin resistance, increasing hepatic gluconeogenesis and inducing β cell dysfunction. The treatment mainly includes oral medication and insulin therapy. This article reviews the research progress of hyperglycemia and diabetes induced by glucocorticoids.
Keywords:diabetes mellitus/
glucocorticoids/
glucose-lowering drugs/
DPP-4 inhibitor/
GLP-1 receptor agonists/
insulin

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https://journal.dmu.edu.cn/data/article/export-pdf?id=dlykdxxb_20220212