CHU Dijon, service d'endocrinologie, diabétologie, maladies métaboliques, hôpital François-Mitterrand, 21034 Dijon cedex, France.
CHU Dijon, service d'endocrinologie, diabétologie, maladies métaboliques, hôpital François-Mitterrand, 21034 Dijon cedex, France.
Ann Endocrinol (Paris). 2018 Oct;79(5):574-582. doi: 10.1016/j.ando.2018.07.011. Epub 2018 Aug 1.
Tyrosine kinase inhibitors (TKI) interfere with glucose metabolism. Contrasting effects have been reported, even for a given molecule. Hyperglycemia rates range between 15 and 40%; nilotinib seems to be the molecule most liable to induce diabetes. Metabolic effects range from metabolic syndrome to onset of diabetes, requiring treatment based on insulin resistance, although pathophysiology is unclear. It is noteworthy that fulminant diabetes has never been reported under TKIs. TKIs may lead to hypoglycemia in type 1 or 2 diabetes. Several cases have been reported of improvement in glycemia and in HbA1c, with reduction or even termination of insulin therapy, mainly under imatinib and sunitinib. Fasting glucose levels should be checked before, during and after treatment, plus HbA1C in diabetic patients, with reinforced self-monitoring. These side-effects are transient and never contraindicate continuation of TKIs. Dyslipidemia under TKI has been reported, concerning both LDL-cholesterol and triglycerides. Although variations seem to be slight, lipid assessment is recommended before, during and after treatment.
酪氨酸激酶抑制剂（TKI）会干扰葡萄糖代谢。即使对于给定的分子，也有报道称其具有相反的作用。高血糖发生率在 15%至 40%之间；尼洛替尼似乎是最容易引发糖尿病的分子。代谢作用范围从代谢综合征到糖尿病的发作，需要根据胰岛素抵抗进行治疗，尽管其病理生理学尚不清楚。值得注意的是，从未有报道称 TKI 会引发暴发性糖尿病。TKI 可导致 1 型或 2 型糖尿病患者发生低血糖。有报道称，几例患者的血糖和 HbA1c 得到改善，胰岛素治疗减少甚至终止，主要是在使用伊马替尼和舒尼替尼时。应在治疗前、治疗期间和治疗后检查空腹血糖水平，以及糖尿病患者的 HbA1C，并加强自我监测。这些副作用是短暂的，从未有过停止 TKI 治疗的禁忌症。TKI 会引起血脂异常，包括 LDL-胆固醇和甘油三酯。尽管变化似乎很小，但建议在治疗前、治疗期间和治疗后进行血脂评估。
