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目的:调查2型糖尿病患者加用吡格列酮所致水肿的临床特点及肝肾功能和促甲状腺激素水平的变化。方法:2008年1月至12月期间8例服用降糖药加吡格列酮治疗的2型糖尿病患者纳入回顾性调查研究。8例患者中男2例,女6例,年龄52～68岁,平均(58.62±5.65)岁。所有患者均服用2种以上降糖药(二甲双胍、格列喹酮、那格列奈、胰岛素、瑞格列奈、阿卡波糖),并加用吡格列酮15～30 mg/d。调查患者加用吡格列酮后水肿出现和消退时间及其临床特点。于吡格列酮服用前、服用期间及水肿消退后2周进行尿常规和肝、肾功能检查;并于水肿发生时和水肿消退后2周测定促甲状腺激素(TSH)水平。结果:所有患者在服用吡格列酮5～10 d发生水肿,其临床特点为双足和双侧小腿呈指压凹陷性水肿,停药2～7 d水肿消退。吡格列酮服用前,服用期间及水肿消退后2周实验室检查示:尿蛋白均为阴性;血清尿素中位数分别为6.20 mmol/L、6.36mmol/L和5.90 mmol/L;SCr中位数分别为83.5μmol/L、87.0μmol/L和78.0μmol/L;ALT中位数分别为31.5 U/L、32.0 U/L和33.0 U/L;在水肿发生时与水肿消退后2周,TSH中位数分别为7.1 mU/L和6.9 mU/L。结论:服用降糖药的2型糖尿病患者加用吡格列酮可出现双足和双侧小腿指压凹陷性水肿,但对肝、肾功能和促甲状腺激素水平无影响,水肿在停药后迅速消退。
Objective: To investigate the clinical characteristics of patients with type 2 diabetes plus pioglitazone-induced edema and changes in liver and kidney function and thyroid-stimulating hormone levels. Methods: Eight patients with type 2 diabetes treated with hypoglycemic agents plus pioglitazone from January to December 2008 were included in the retrospective study. There were 2 males and 6 females in 8 patients, aged from 52 to 68 years, with an average of (58.62 ± 5.65) years. All patients took more than two hypoglycemic agents (metformin, gliquidone, nateglinide, insulin, repaglinide, acarbose) plus pioglitazone 15-30 mg / d. Investigation of patients with pioglitazone after emergence and regression of edema and clinical features. Urine and liver and renal function tests were performed 2 weeks before, during and after the administration of pioglitazone, and thyroid-stimulating hormone (TSH) levels were measured 2 weeks after the onset of edema and edema. Results: All patients had edema on pioglitazone 5-10 days after taking pioglitazone. The clinical features were depression with acupressure on both feet and bilateral lower limbs, and edema disappeared after 2-7 days of withdrawal. Two weeks after the administration of pioglitazone and during the period of taking the drug and the edema subsided, laboratory tests showed that urine protein was negative, and the median of serum urea was 6.20 mmol / L, 6.36 mmol / L and 5.90 mmol / L respectively. The median of SCr was Were 83.5μmol / L, 87.0μmol / L and 78.0μmol / L respectively. The median ALT was 31.5 U / L, 32.0 U / L and 33.0 U / L, respectively. The median is 7.1 mU / L and 6.9 mU / L, respectively. Conclusion: Patients with type 2 diabetes who take hypoglycemic agents plus pioglitazone may have bipedal and bilateral acupressure depression edema, but have no effect on liver and kidney function and thyroid stimulating hormone levels. Edema quickly subsides after withdrawal.