中国药物警戒 ›› 2026, Vol. 23 ›› Issue (10): 1185-1187.
DOI: 10.19803/j.1672-8629.20260498

• 安全与合理用药 • 上一篇    下一篇

纳武利尤单抗致暴发性1型糖尿病合并糖尿病酮症酸中毒及高渗高血糖状态1例分析

王泽滨1,2, 江志伟2, 龚冠闻2*   

  1. 1南京中医药大学第一临床医学院,江苏 南京 210023;
    2南京中医药大学附属医院普外科,江苏 南京 210029
  • 收稿日期:2026-06-16 出版日期:2026-10-15 发布日期:2026-10-16
  • 通讯作者: *龚冠闻,男,博士,主任医师,肿瘤临床药学。E-mail: love_ggw2@163.com
  • 作者简介:王泽滨,男,在读硕士,肿瘤临床药学。
  • 基金资助:
    江苏省医学重点学科项目（ZDXK202251）;江苏省研究生科研实践创新计划项目（26CXJH3892）江苏省研究生实践创新计划（SJCX25-1027）

One case of fulminant type 1 diabetes mellitus complicated with diabetic ketoacidosis and hyperosmolar hyperglycemic state caused by nivolumab

Wang Zebin1,2, Jiang Zhiwei2, Gong Guanwen2*   

  1. 1The First School of Clinical Medicine, Nanjing University of Chinese Medicine, Nanjing Jiangsu 210023, China;
    2Department of General Surgery, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing Jiangsu 210029, China
  • Received:2026-06-16 Online:2026-10-15 Published:2026-10-16

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摘要： 目的 探讨纳武利尤单抗致暴发性1型糖尿病（FT1DM）合并糖尿病酮症酸中毒（DKA）及高渗高血糖状态（HHS）的临床特征、发生机制及救治策略,为临床安全用药提供警示。方法 分析1例膀胱尿路上皮癌患者接受纳武利尤单抗治疗后并发FT1DM及重度代谢紊乱的病例,并结合国内外相关文献进行关联性判定及机制探讨。结果 患者在使用纳武利尤单抗后致FT1DM合并DKA及HHS,该不良反应与纳武利尤单抗的关联评价为“很可能”,予液体复苏、胰岛素强化治疗后,患者代谢危象纠正,出院后需终身使用外源性胰岛素治疗。结论 纳武利尤单抗可诱发FT1DM,其不良反应起病急骤,且造成的胰岛β细胞损伤具有不可逆性。临床用药期间应将血糖纳入常规监测,对于疑似患者忌用大剂量糖皮质激素,早期识别与多学科协同抢救是挽救生命的关键。

关键词: 纳武利尤单抗, 暴发性1型糖尿病, 糖尿病酮症酸中毒, 高渗高血糖状态, 免疫相关不良事件

Abstract: Objective To explore the clinical characteristics, underlying pathogenesis, and management strategies related to nivolumab-induced fulminant type 1 diabetes mellitus (FT1DM) complicated by diabetic ketoacidosis (DKA) and hyperosmolar hyperglycemic state (HHS) in order to provide crucial pharmacovigilance insights for safe medication. Methods The clinical data of a patient with bladder urothelial carcinoma, who developed FT1DM and severe metabolic derangements following nivolumab therapy, was retrospectively analyzed. Causality was assessed and the mechanism was explored based on literature review. Results The patient experienced an abrupt onset of FT1DM concurrent with DKA and HHS following the administration of nivolumab. The causality between this adverse drug reaction and nivolumab was graded as “probable”. Following aggressive fluid resuscitation and intensive insulin therapy, the metabolic crisis was reversed. However, the patient was discharged with lifelong dependence on exogenous insulin replacement. Conclusion Nivolumab can precipitate FT1DM, a life-threatening condition characterized by rapid progression and irreversible destruction of pancreatic islets. Routine glycemic monitoring should be mandated during clinical administration. Notably, high-dose corticosteroids are contraindicated in suspected cases. Early recognition and a multidisciplinary approach are critical to preventing fatal outcomes.

Key words: Nivolumab, Fulminant Type 1 Diabetes Mellitus(FT1DM), Diabetic Ketoacidosis(DKA), Hyperosmolar Hyperglycemic State(HHS), Immune-Related Adverse Events(irAEs)

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