2型糖尿病患者中的二甲双胍与乳酸性酸中毒——从傲慢与偏见到理智与情感
Metformin and lactic acidosis in patients with type 2 diabetes--from pride and prejudice to sense and sensibility.
作者信息
Papanas N, Monastiriotis C, Christakidis D, Maltezos E
机构信息
Second Department of Internal Medicine, Democritus University of Thrace, Greece.
出版信息
Acta Clin Belg. 2009 Jan-Feb;64(1):42-8. doi: 10.1179/acb.2009.008.
AIM
To present the cases of lactic acidosis encountered in our department among metformin-treated type 2 diabetic patients and to investigate the role of contraindications to metformin use.
METHODS
A survey of medical records of metformin-treated type 2 diabetic patients hospitalised for various medical conditions during the years 2004-2005 who exhibited elevated serum concentrations of lactic acid.
RESULTS
Seven metformin-treated type 2 diabetic patients were identified who were not attending our department and were hospitalised with elevated serum lactic acid levels (6 developed lactic acidosis). All patients had one or more contraindications to metformin use. Outcome was favourable in 6 patients, while 1 patient with hepatocellular carcinoma died of liver failure.
CONCLUSIONS
So far, metformin is one of the safest first-line oral hypoglycaemic agents. However, caution is needed to avoid patients with evident contraindications. This highlights the need for the practitioner to possess sound clinical judgement when prescribing metformin.
目的
介绍我院二甲双胍治疗的2型糖尿病患者中发生乳酸酸中毒的病例，并探讨二甲双胍使用禁忌的作用。
方法
对2004 - 2005年间因各种疾病住院的二甲双胍治疗的2型糖尿病患者的病历进行调查，这些患者血清乳酸浓度升高。
结果
确定了7例未在我院就诊但因血清乳酸水平升高而住院的二甲双胍治疗的2型糖尿病患者（6例发生乳酸酸中毒）。所有患者均有一项或多项二甲双胍使用禁忌。6例患者预后良好，1例肝细胞癌患者死于肝功能衰竭。
结论
到目前为止，二甲双胍是最安全的一线口服降糖药之一。然而，需要谨慎避免有明显禁忌证的患者。这凸显了从业者在开具二甲双胍处方时具备良好临床判断力的必要性。
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