在移植接受者的新发病糖尿病酸性酸症中
Havird McLean Skalak1, Kaitlyn Haas2, Melissa Laub3
1Mercer University School of Medicine, Savannah, Georgia.
The American journal of the medical sciences
|August 30, 2024
概括
移植后糖尿病 (PTDM) 可能与糖尿病酸性脂肪酸 (DKA) 异常表现,即使在没有典型危险因素的患者中也是如此. 这一案例突出了塔克罗利斯毒性和成年人潜在的自身免疫糖尿病 (LADA) 的潜在原因.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 内分泌学 在内分泌学.
- 免疫学 免疫学 免疫学
背景情况:
- 移植后糖尿病 (PTDM) 是固体器官移植后的一个常见并发症.
- 免疫抑制剂,特别是塔克罗利斯,经常与PTDM发展有关.
- PTDM通常表现为2型糖尿病,糖尿病酸性糖尿病 (DKA) 是一种罕见的表现.
研究的目的:
- 报告一个罕见的PTDM病例,在接受脏移植的接受者中呈现DKA.
- 在本报告中调查塔克罗利斯毒性和自身免疫过程的潜在作用.
- 突出考虑LADA在新发糖尿病和DKA的移植后患者中的重要性.
主要方法:
- 一个38岁的男性脏移植接受者的病例报告.
- 分析了临床表现,实验室发现 (高血糖症,尿症,代谢性酸症) 和塔克罗利斯水平.
- 诊断工作包括评估胰岛素缺乏症,C-水平和抗GAD抗体.
- 进行了tacrolimus诱导的DKA病例的文献审查.
主要成果:
- 这位患者在接受LCP-tacrolimus治疗时,在移植后四个月接受了DKA.
- 怀疑DKA是由于塔克罗利斯诱导的胰腺β细胞损伤,由超治疗药物水平加剧.
- 成年人潜在自身免疫糖尿病 (LADA) 的诊断得到了胰岛素缺失,低C和阳性抗GAD抗体的证实.
- 文献综述只发现了16例前期的塔克罗利斯诱导的DKA病例,没有报告抗GAD阳性.
结论:
- 这种病例代表了DKA的独特PTDM呈现,可能是自免疫 (LADA) 和塔克罗利斯诱导的β细胞破坏的结合结果.
- 医生应该警新发病的LADA和TACROLIMUS诱导的DKA移植后,即使在缺乏传统风险因素的患者中也是如此.
- 抗GAD抗体查可能有助于识别服用塔克罗利斯的PTDM患者,这些患者不太可能恢复β细胞功能.
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