PERIOPERATIVE DIABETIC KETOACIDOSIS ASSOCIATED WITH SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS : A SYSTEMATIC REVIEW
PERIOPERATIVE DIABETIC KETOACIDOSIS ASSOCIATED WITH SODIUM-GLUCOSE CO-TRANSPORTER-2 INHIBITORS : A SYSTEMATIC REVIEW
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与钠-葡萄糖协同转运蛋白 2 抑制剂相关的围手术期糖尿病酮症酸中毒：系统评价
DOI：
10.53555/nnmhs.v9i6.1723
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发表时间：
2023
期刊：
影响因子：
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通讯作者：
Hananya Dwi Anggi Manurung
中科院分区：
文献类型：
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作者：
Hananya Dwi Anggi Manurung
DKA或糖尿病酮症酸中毒是由高血糖症引起的紧急情况，其中血液中产生过量的酸。1型和2型糖尿病患者接受手术，感染或处于极端压力下也可能发生DKA。身体产生激素肾上腺素来对抗感染和压力，但这会对血糖水平产生负面影响（肾上腺素是胰岛素的反作用）。如果患者在压力或感染情况下拒绝服用糖尿病药物或注射胰岛素，情况可能会恶化。在糖尿病酮症酸中毒（DKA）中起作用的病理生理机制的基本组成部分包括激素水平的变化和随后的炎症反应。激素浓度的改变导致葡萄糖的产生和消耗的变化，以及脂解和酮体形成的增加。卡格列净、达格列净、恩格列净和厄图格列净是美国食品药品监督管理局（FDA）批准用于治疗成人2型糖尿病（DM）的药物。作用于蛋白质，这四种药物是SGLT 2抑制剂类药物。SGLT-2在肾脏近端小管中表达。这可能导致滤过葡萄糖重吸收减少、肾葡萄糖阈值（RTG）降低和经尿葡萄糖排泄增加。接受钠-葡萄糖转运蛋白2（SGLT 2）抑制剂治疗的糖尿病患者也报告发生DKA。一项研究的结果表明，DKA在接受SGLT 2抑制剂治疗的T2DM患者中并不常见。
DKA or diabetic ketoacidosis is an emergency condition caused by hyperglycemia in which excessive acid is produced in the blood. Patients with type 1 and type 2 diabetes who undergo surgery, have an infection, or are under extreme stress can also develop DKA. The body generates the hormone adrenaline to combat infection and stress, but this can have a negative effect on blood glucose levels (adrenaline is counterinsulin). This can worsen if the patient refuses to take diabetes medication or inject insulin during stressful or infectious situations. The fundamental components of the pathophysiological mechanisms at play in diabetic ketoacidosis (DKA) include shifts in hormone levels and the ensuing inflammatory response. Alterations in the concentration of hormones lead to shifts in the production and consumption of glucose, as well as an increase in lipolysis and the formation of ketone bodies. Canagliflozin, dapagliflozin, empagliflozin, and ertugliflozin are agents approved by the Food and Drug Administration (FDA) for the treatment of type 2 diabetes mellitus (DM) in adults. Acting on proteins, the four agents are SGLT2 inhibitor class agents. SGLT-2 is expressed in the kidney's proximal tubule. This may result in a decrease in filtered glucose reabsorption, a decrease in the renal threshold for glucose (RTG), and an increase in glucose excretion via urine. Diabetes patients treated with sodium–glucose transport protein 2 (SGLT2) inhibitors have also been reported to experience DKA. The results of a study indicate that DKA is uncommon among T2DM patients treated with SGLT2 inhibitors.