gluconeogenesis 3 4 glucagon metformin LDL-C HDL- C metformin metformin (sulfonylurea) - (alpha-glucosidase inhibitor) (thiazolidinedione) MALA 圖二山羊豆,

Size: px

Start display at page:

Download "gluconeogenesis 3 4 glucagon metformin LDL-C HDL- C metformin metformin (sulfonylurea) - (alpha-glucosidase inhibitor) (thiazolidinedione) MALA 圖二山羊豆,"

蠡告许
5 years ago
Views:

Metformin MALA 1,3 1 2 1,4 前言 Metformin American Diabetes Association European Association for the Study of Diabetes

1 Metformin MALA 1, ,4 前言 Metformin American Diabetes Association European Association for the Study of Diabetes metformin-associated lactic acidosis, MALA MALA guanidine metformin, buformin, proguanil phenformin metformin buformin proguanil phenformin 1970 Metformin 圖一胍 metformin 與 phenformin 的結構式 Metformin 的結構與作用機轉 Metformin biguanides 1 台北榮民總醫院家庭醫學部 2 台北榮民總醫院內科部 3 國立陽明大學科技與社會研究所 4 國立陽明大學醫學院家庭醫學科 metformin, metformin-associated lactic acidosis MALA, guanides, regulatory science. metformin 1 glycogenolysis 家庭醫學與基層醫療第十一期

gluconeogenesis 3 4 glucagon metformin LDL-C HDL- C metformin metformin (sulfonylurea) - (alpha-glucosidase inhibitor) (thiazolidinedione) MALA 圖二山羊豆, 其抽取物中富含胍胍類藥物的研發與副作用問題 1500 thiazolidinedione

2 gluconeogenesis 3 4 glucagon metformin LDL-C HDL- C metformin metformin (sulfonylurea) - (alpha-glucosidase inhibitor) (thiazolidinedione) MALA 圖二山羊豆, 其抽取物中富含胍胍類藥物的研發與副作用問題 1500 thiazolidinedione metformin Galega officinalis 1918 isoamylene guanidine 1926 Schering AG synthalin A synthalin B 1950 資料來源 :Witters 2001 圖一 1957 US Vitamin Company Ungar, Freedman Seymour Shapiro phenformin FDA Endocrinology and Metabolism Advisory Committee 1978 phenformin phenformin buformin metformin Grünenthal 家庭醫學與基層醫療第十一期 289

3 buformin 1960 phenformin buformin Jean Sterne metformin phenformin phenformin 1995 FDA Bristol-Myers Squibb glucophage metformin Bailey metformin sulfonylurea phenformin metformin MALA 的文獻分析 metformin pharmacovigilance metformin MALA 1998 Misbin metformin 47 MALA 21 Misbin 43 Bristol- Myers Squibb Comparative Outcomes Study of Metformin Intervention Versus Conventional Approach ,227 metformin 1,505 Salpeter metformin 36,000 / patient-years metformin 表一使用 metformin 使用的排除標準腎功能損害 : 男性血清酐酸大於 1.5 mg/dl( 或 132 umol/l), 女性血清肌酐酸大於 1.4 mg/dl( 或 124 umol/l) 可能導致缺氧或降低周邊灌注的心或肺功能不全有乳酸血症的病史會降低組織灌注的嚴重感染顯示肝功能指數不正常的肝病變 ( 包含酒精性肝病變 ) 足以造成急性肝中毒的酒精濫用與狂飲 * 使用靜脈內顯影劑 ** * 如果肝功能正常, 中度飲酒不是使用 metformin 的禁忌 ** 目前還不清楚注射靜脈內顯影劑之後造成的乳酸血症, 部分是因為既有的腎臟疾病與接受放射造影前減少攝取水分的緣故資料來源 : Bailey and Day 2004 表四 290 家庭醫學與基層醫療第十一期

4 MALA metformin MALA MALA 3 2 metformin ICU 17 metformin 2002 metformin 1,000mg 75 6 metformin 1,000mg MALA MALA metformin 2 lactate MALA metformin MALA MALA Lipska, Bailey, Inzucchi 2011 Diabetes Care MALA 10 3 FDA 臨床上的對策 metformin MALA MALA MALA FDA metformin 1.5 mg/dl 1.4 mg/dl metformin National Institutes for Health and Clinical Excellence metformin 2009 metformin 1.5 mg/dl 1.4 mg/dl 家庭醫學與基層醫療第十一期 291

5 metformin egfr 0.5 ml/min 1.9 ml/ min egfr metformin 2010 Australian Diabetes Society Canadian Diabetes Association egfr metformin MALA 1 2 metformin 45.0 mg/dl 5.0 mmol/l PH 7.35 metformin metformin metformin orlistat metformin 表二臨床上以 egfr 為標準對使用 metformin 的建議腎絲球過濾率 egfr (ml/min per 1.73 m 2 ) 60 <60 且 45 <45 且 30 <30 建議無使用 metformin 的禁忌宜每年監測腎功能繼續使用 metformin 需較頻繁地監測腎功能 ( 每三個月到半年監測一次 ) 開立 metformin 時要特別注意使用較低劑量的 metformin( 例如 : 減至正常劑量的一半 ) 每三個月監測腎功能從未使用過 metformin 的病人, 不建議開立停止使用 metformin 資料來源 : 改編自 Lipska, Bailey, Inzucchi 2010 表一 292 家庭醫學與基層醫療第十一期

6 metformin 48 結語 metformin metformin metformin MALA MALA metformin MALA metformin compliance 參考資料 1. Bailey CJ, Day C: Metformin: its botanical background. Prac Diab Int 2004; 21: Bailey CJ: Biguanides and NIDDM. Diabetes Care 1992; 15: Chang CT, Chen YC, Fang JT, Huang CC: Metformin-associated lactic acidosis: case reports and literature review. J Nephrol 2002; 15: Chu CK, Chang YT, Lee BJ, Hu SY, Hu WH, Yang DY: Metformin-associated lactic acidosis and acute renal failure in a type 2 diabetic patient. J Chin Med Assoc 2002; 66: Crofford OB: Metformin (editorial). New Eng J Med 1995; 333: Hsu CN, Chang CH, Lin JH, Tai YK: Outcome of metformin-associated lactic acidosis in type 2 diabetic patients. J Intern Med Taiwan 2012; 23: Lin YC, Lin LY, Wang HF, Lin HD: Fasting plasma lactate concentrations in ambulatory elderly patients with type 2 diabetes receiving metformin therapy: a retrospective cross-sectional study. J Chin Med Assoc 2010; 73: Lipska KJ, Bailey CJ, Inzucchi SE: Use of metformin in the setting of mild-to-moderate renal insufficiency. Diabetes Care 2010; 34: Misbin RI, Green L, Stadel BV, Gueriguian JL, Gubbi A, Fleming GA: Lactic acidosis in patients with diabetes treated with metformin. N Eng J Med 1998; 338: Misbin RI: The phantom of lactic acidosis due to metformin in patients with diabetes. Diabetes Care 2004; 27: Stades AM, Heiken JT, Erkelens DW, Holleman F, Hoekstra JB: Metformin and lactic acidosis: cause or coincidence? A review of case reports. J Int Med 2004; 255: Williams RH, Palmer JP: Farewell to phenformin for treating diabetes mellitus. Ann Intern Med 1975; 83: Witters LA: The blooming of the French lilac. J Clin Invest 2001; 108: Wood AJJ, Bailey CJ, Turner RC: Metformin. New Eng J Med 1996; 334: 家庭醫學與基層醫療第十一期 293

fibroblast growth factor, FGF D 25-OH Vit D D 25-OH Vit D [2] D 200 IU D D 25- OH Vit D D [3] 維生素 D 缺乏 D vitamin D deficiency 25-OH Vit D 10 ng/ml 25

fibroblast growth factor, FGF D 25-OH Vit D D 25-OH Vit D [2] D 200 IU D D 25- OH Vit D D [3] 維生素 D 缺乏 D vitamin D deficiency 25-OH Vit D 10 ng/ml 25 D 家庭醫業 1 2 3 4 前言維生素 D 的來源及合成 D vitamin D deficiency D D vitamin D insufficiency D D D 1 台北榮民總醫院家庭醫學部住院醫師 2 台北榮民總醫院家庭醫學部住院醫師 3 台北榮民總醫院家庭醫學部主治醫師 4 台北榮民總醫院家庭醫學部主任國立陽明大學醫學系教授兼家庭醫學科主任 vitamin D deficiency,