1例对多种胰岛素制剂过敏的妊娠期糖尿病患者的用药分析及药学监护
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摘要
1例31岁女性患者,因"停经25周发现血糖升高,经OGTT确诊为妊娠期糖尿病,注射胰岛素后出现荨麻疹半个月余"入院,入院诊断为妊娠期糖尿病。入院后行降糖治疗,考虑患者先后给予多种胰岛素注射后均在注射部位出现局部红色片状荨麻疹过敏症状,临床药师与医师充分沟通后提出给予胰岛素泵持续皮下输注小剂量生物合成人胰岛素脱敏治疗,医师采纳建议。患者经胰岛素脱敏治疗后未再出现过敏情况,逐渐增加胰岛素剂量,直至血糖控制达标,治疗期间临床药师持续关注药物疗效及不良反应,对患者进行用药教育,院外随访2个月,患者血糖控制良好。
A 31-year-old female patient with gestational diabetes mellitus diagnosed by OGTT at the 25th week of gestation developed red flaky urticaria in the injection site after using multiple insulin preparations for half a month. Considered that the patient was allergic to multiple insulin preparations, clinical pharmacist suggested giving her the desensitization therapy of continuous subcutaneous infusion with small dose biosynthetic human insulin injection through insulin pump. The blood glucose of the patient was well controlled after gradually increasing the dose of insulin without allergy. During the treatment, the clinical pharmacist continuously paid attention to the drug effect and adverse drug reactions, and medication education was given to her. The patient's blood glucose was well controlled after 2 months of follow-up.
A 31-year-old female patient with gestational diabetes mellitus diagnosed by OGTT at the 25th week of gestation developed red flaky urticaria in the injection site after using multiple insulin preparations for half a month. Considered that the patient was allergic to multiple insulin preparations, clinical pharmacist suggested giving her the desensitization therapy of continuous subcutaneous infusion with small dose biosynthetic human insulin injection through insulin pump. The blood glucose of the patient was well controlled after gradually increasing the dose of insulin without allergy. During the treatment, the clinical pharmacist continuously paid attention to the drug effect and adverse drug reactions, and medication education was given to her. The patient's blood glucose was well controlled after 2 months of follow-up.
引文
[1]Langer O.Pharmacological treatment of gestational diabetesmellitus:point/counterpoint[J].Am J Obstet Gynecol,2018,218(5):490-499.
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[4]Kim GJ,Kim SB,Jo SI,et al.Two case of allergy to insulin in gestational diabetes[J].Endocrinol Metab(Seoul),2015,30(3):402-407.
[5]Ben AI,Ksouri H,Trabelsi N,et al.Generalized allergy due to zinc in insulin treated with zinc-free insulin[J].Acta Diabetol,2012,49(3):239-241.
[6]王宇,闫娜娜,卫国红,等.多种胰岛素过敏的1型糖尿病患者脱敏一例及文献复习[J].中华糖尿病杂志,2013,5(5):279-281.
[7]Pazos M,Sperling RS,Moran TM,et al.The influence of pregnancy on systemic immunity[J].Immunol Res,2012,54(1-3):254-561.
[8]Villalobos-Labra R,Silva L,Subiabre M,et al.Akt/mTOR role in human foetopacetal vascular insulin resistance in diseases of pregnancy[J].J Diabetes Res,2017,9:1-13.
[9]杨慧霞.妊娠合并糖尿病对孕妇和围产儿的影响[J].中华医学信息导报,2005,20(3):14.
[10]Subiabre M,Silva L,Toledo F,et al.Insulin therapy and its consequences for the mother,foetus,and newborn in gestational diabetes mellitus[J].Biochim Biophys Acta Mol Basis Dis,2018,1864(9 Pt B):2949-2956.
[11]Kc K,Shakya S,Zhang H.Gestational diabetes mellitus and macrosomia:a literature review[J].Ann Nutr Metab,2015,66(Suppl 2):14-20.
[12]中国医师协会内分泌代谢科医师分会,中华医学会内分泌学分会,中华医学会糖尿病学分会.中国胰岛素泵治疗指南(2014)[J].糖尿病天地,2014,8(9):404-409.
[13]Fujikawa T,Imbe H,Date M,et al.Severe insulin allergy successfully treated with continuous subcutaneous insulin infusion[J].Diabetes Res Clin Pract,2012,97(2):e31-e33.
[14]舒筠然,柯亭羽.谷赖胰岛素治疗胰岛素过敏患者疗效与体会[J].实用糖尿病杂志,2018,14(4):69-71.
[15]晋溶辰,黄金.胰岛素制剂过敏反应的临床特点及处理[J].中华内分泌代谢杂志,2013,29(9):9a-1-4.
[16]Haastrup MB,Henriksen JE,Mortz CG,et al.Insulin allergy can be successfully managed by a systematic approach[J].Clin Transl Allergy,2018,8:35.
[17]郭惠娟,江美芳,刘静慧,等.妊娠期糖尿病的药学服务及其临床效果分析[J].中国医院药学杂志,2017,37(24):2500-2504.
[18]黄赞怡,李雪娇,戴小萍.胰岛素泵持续强化治疗妊娠期糖尿病的临床研究[J].中国临床药理学杂志,2018,34(15):1792-1795.
[2]苗志荣,吴红花.妊娠期糖尿病诊断与治疗研究进展[J].中国糖尿病杂志,2017,25(4):365-370.
[3]Jacquier J,Chik CL,Senior PA.A practical,clinical approach to the assessment and management of suspected insulin allergy[J].Diabet Med,2013,30(8):977-985.
[4]Kim GJ,Kim SB,Jo SI,et al.Two case of allergy to insulin in gestational diabetes[J].Endocrinol Metab(Seoul),2015,30(3):402-407.
[5]Ben AI,Ksouri H,Trabelsi N,et al.Generalized allergy due to zinc in insulin treated with zinc-free insulin[J].Acta Diabetol,2012,49(3):239-241.
[6]王宇,闫娜娜,卫国红,等.多种胰岛素过敏的1型糖尿病患者脱敏一例及文献复习[J].中华糖尿病杂志,2013,5(5):279-281.
[7]Pazos M,Sperling RS,Moran TM,et al.The influence of pregnancy on systemic immunity[J].Immunol Res,2012,54(1-3):254-561.
[8]Villalobos-Labra R,Silva L,Subiabre M,et al.Akt/mTOR role in human foetopacetal vascular insulin resistance in diseases of pregnancy[J].J Diabetes Res,2017,9:1-13.
[9]杨慧霞.妊娠合并糖尿病对孕妇和围产儿的影响[J].中华医学信息导报,2005,20(3):14.
[10]Subiabre M,Silva L,Toledo F,et al.Insulin therapy and its consequences for the mother,foetus,and newborn in gestational diabetes mellitus[J].Biochim Biophys Acta Mol Basis Dis,2018,1864(9 Pt B):2949-2956.
[11]Kc K,Shakya S,Zhang H.Gestational diabetes mellitus and macrosomia:a literature review[J].Ann Nutr Metab,2015,66(Suppl 2):14-20.
[12]中国医师协会内分泌代谢科医师分会,中华医学会内分泌学分会,中华医学会糖尿病学分会.中国胰岛素泵治疗指南(2014)[J].糖尿病天地,2014,8(9):404-409.
[13]Fujikawa T,Imbe H,Date M,et al.Severe insulin allergy successfully treated with continuous subcutaneous insulin infusion[J].Diabetes Res Clin Pract,2012,97(2):e31-e33.
[14]舒筠然,柯亭羽.谷赖胰岛素治疗胰岛素过敏患者疗效与体会[J].实用糖尿病杂志,2018,14(4):69-71.
[15]晋溶辰,黄金.胰岛素制剂过敏反应的临床特点及处理[J].中华内分泌代谢杂志,2013,29(9):9a-1-4.
[16]Haastrup MB,Henriksen JE,Mortz CG,et al.Insulin allergy can be successfully managed by a systematic approach[J].Clin Transl Allergy,2018,8:35.
[17]郭惠娟,江美芳,刘静慧,等.妊娠期糖尿病的药学服务及其临床效果分析[J].中国医院药学杂志,2017,37(24):2500-2504.
[18]黄赞怡,李雪娇,戴小萍.胰岛素泵持续强化治疗妊娠期糖尿病的临床研究[J].中国临床药理学杂志,2018,34(15):1792-1795.