Service de gastroentérologie, hôpital Avicenne, AP-HP, université Paris-V René-Descartes, 125, route de Stalingrad, 93009 Bobigny, France.
Diabetes Metab. 2011 Apr;37(2):90-6. doi: 10.1016/j.diabet.2010.11.002. Epub 2011 Jan 13.
Digestive disorders (diarrhoea, vomiting) represent the most common metformin side-effects (around 30%) with this first-line drug treatment for type 2 diabetes. In healthy individuals, metformin affects glucose, vitamin B12 and the digestive uptake of bile salts. In the colon, it acts locally by modifying glucose cell metabolism. Different pathophysiological hypotheses have been proposed to explain the metformin-induced diarrhoea and vomiting, which can sometimes cause the patient to stop an effective treatment. These theories include stimulation of intestinal secretion of serotonin, changes in incretin and glucose metabolism, and bile-salt malabsorption. However, none of these hypotheses can be considered an adequate pathophysiological explanation of metformin digestive side-effects. In addition, there is a lack of experimental data to explain these highly patient-dependent adverse effects.
消化紊乱（腹泻、呕吐）是二甲双胍最常见的副作用（约 30%），这种药物是治疗 2 型糖尿病的一线药物。在健康个体中，二甲双胍会影响葡萄糖、维生素 B12 和胆汁盐的消化道吸收。在结肠中，它通过改变葡萄糖细胞代谢发挥局部作用。已经提出了不同的病理生理假说来解释二甲双胍引起的腹泻和呕吐，这些副作用有时会导致患者停止有效的治疗。这些理论包括刺激肠内 5-羟色胺的分泌、肠促胰岛素和葡萄糖代谢的变化以及胆汁盐吸收不良。然而，这些假说都不能被认为是二甲双胍消化道副作用的充分病理生理学解释。此外，缺乏实验数据来解释这些高度依赖于患者的不良反应。
