解放军医学杂志2025，Vol.50Issue(9)：1103-1109,7.DOI:10.11855/j.issn.0577-7402.0954.2025.0812
免疫检查点抑制剂相关糖尿病10例临床特征分析并文献复习
Clinical characteristics of 10 cases of immune checkpoint inhibitor-related diabetes mellitus and literature review
摘要
Abstract
Objective To analyze the clinical characteristics,treatment,and prognosis of immune checkpoint inhibitor-related diabetes mellitus(ICI-DM).Methods The clinical characteristics,laboratory examinations,treatment regimens,and follow-up outcomes of 10 ICI-DM patients who were diagnosed and treated in the First Medical Center of Chinese PLA General Hospital between July 2019 and December 2024 were retrospectively analyzed.Relevant literatures were retrieved from domestic and foreign databases such as PubMed,CNKI,and VIP.The clinical characteristics of ICI-DM were summarized based on the literature results.Results All 10 patients were PD-1 inhibitor users,including 5 males and 5 females,with a median age of 54.5(51.3,64.0)years and a body mass index(BMI)of(22.0±2.15)kg/m2.Among them,9 cases(90.0%)were fulminant type 1 diabetes mellitus(FT1DM);9 cases(90.0%)had a severity of adverse events reaching grade 3-4 according to the Common Terminology Criteria for adverse events(CTCAE).The median time from PD-1 inhibitor treatment to the occurrence of the classic diabetes symptoms referred to as"three more and one less"(polyuria,polydipsia,polyphagia,and weight loss)in all patients was 145.5(110.5,204.8)days,and the medication duration was 6.0(4.3,7.8)cycles.The average blood glucose level of the 10 patients at the time of consultation was 25.3(10.0-41.4)mmol/L,and the glycated hemoglobin(HbA1c)level was 8.0%(6.6%-10.9%).Eight patients had fasting and 2-hour C-peptide levels<0.1 ng/ml(fasting C-peptide from<0.010 to 0.067 ng/ml,2-hour C-peptide from<0.010 to 0.077 ng/ml).Nine of the 10 patients were negative for diabetes autoantibodies,while 1 was not tested.All 10 patients were successfully treated with insulin and other therapies.During the follow-up after discharge,all patients still relied on insulin treatment,and no significant recovery of pancreatic islet β cell function was observed compared with that at discharge.Literature review revealed that ICI-DM was more common in PD-1 inhibitor users,with clinical mainly manifested as diabetic ketoacidosis(DKA)(65.4%)and diabetic ketosis(13.1%).Patients had severely impaired pancreatic islet function and required long-term insulin treatment,and some cases were complicated by thyroid or pituitary dysfunction.Conclusions ICI-DM typically presents as FT1DM,often manifesting with DKA or diabetic ketosis at onset.It is characterized by severe and irreversible loss of pancreatic islet function,necessitating lifelong insulin therapy.To enable early detection and prompt treatment,close monitoring of blood glucose is essential during ICI treatment.关键词
免疫检查点抑制剂相关糖尿病/暴发性1型糖尿病/糖尿病酮症酸中毒/胰岛素/血糖监测Key words
immune checkpoint inhibitor-related diabetes mellitus/fulminant type 1 diabetes mellitus/diabetic ketoacidosis/insulin/blood glucose monitoring分类
医药卫生引用本文复制引用
宫雯雯,李树,陈予龙,臧丽,杜锦,王先令,吕朝晖,郭清华..免疫检查点抑制剂相关糖尿病10例临床特征分析并文献复习[J].解放军医学杂志,2025,50(9):1103-1109,7.基金项目
This work was supported by the Hainan Provincial Key Research and Development Project(ZDYF2018117),the Hainan Provincial Health and Family Planning Commission Project(15A200071),and the Sanya Science and Technology Innovation Project(2017YW16) 海南省重点研发项目(ZDYF2018117) （ZDYF2018117）
海南省卫计委课题(15A200071) （15A200071）
三亚科技创新项目(2017YW16) （2017YW16）
