摘要

Although metformin has been used for over 60 years, the balance between the drug's beneficial and adverse effects is still subject to debate. Following an analysis of how cases of so-called "metformin-associated lactic acidosis" (MALA) are reported in the literature, the present article reviews the pitfalls to be avoided when assessing the purported association between metformin and lactic acidosis. By starting from pathophysiological considerations, we propose a new paradigm for lactic acidosis in metformin-treated patients. Metformin therapy does not necessarily induce metformin accumulation, just as metformin accumulation does not necessarily induce hyperlactatemia, and hyperlactatemia does not necessarily induce lactic acidosis. In contrast to the conventional view, MALA probably accounts for a smaller proportion of cases than either metformin-unrelated lactic acidosis or metformin-induced lactic acidosis. Lastly, this review highlights the need for substantial improvements in the reporting of cases of lactic acidosis in metformin-treated patients. Accordingly, we propose a check-list as a guide to clinical practice.

译文

尽管二甲双胍已经使用了 60 多年,但该药物的有益作用和不良作用之间的平衡仍有争议。在分析了文献中如何报道所谓的 “二甲双胍相关的乳酸酸中毒” (MALA) 的病例之后, 本文综述了在评估二甲双胍和乳酸酸中毒之间的所谓关联时要避免的陷阱。通过从病理生理学的考虑出发,我们提出了一种针对二甲双胍治疗患者乳酸酸中毒的新范例。二甲双胍治疗不一定诱发二甲双胍的蓄积,正如二甲双胍的蓄积不一定诱发高乳酸血症一样,高乳酸血症也不一定诱发乳酸酸中毒。与传统观点相反,MALA 可能比二甲双胍无关的乳酸酸中毒或二甲双胍引起的乳酸酸中毒占更少的比例。最后,这篇综述强调了在报告二甲双胍治疗患者的乳酸酸中毒病例时需要进行实质性改进。因此,我们提出了一个检查表作为临床实践的指南。

Lactic acidosis

内分泌 代谢性酸中毒 疾病
概述  :  

乳酸性酸中毒是代谢性酸中毒的一种形式,原因是一个人生产过多或未充分利用乳酸,但是他们的身体对乳酸这样的变化却无法适应。乳酸性酸中毒的人的肝脏(有时是肾脏)能够从体内清除多余的酸。如果乳酸在体内积累的速度快于其被清除的速度,那么体液(例如血液)中的酸度水平就会飙升。这种酸的积累会导致人体的pH值失衡,应该始终是弱碱性而不是酸性。有几种不同类型的酸中毒。当肌肉中的氧气不足以分解葡萄糖和糖原时,就会发生乳酸堆积。这称为无氧代谢。乳酸有两种:L-乳酸和D-乳酸。病理原因①心脏病:诸如心脏疾病和充血性

lactic   英 /'læktɪk/   美 /'læktɪk/

释    义   adj. 乳的;乳汁的

例    句   The somewhat acid flavour is caused by the presence of lactic acid. 这种微酸的味道是因为含有乳酸造成的。

 

acidosis   英 /,æsɪ'dəʊsɪs/   美 /,æsɪ'dosɪs/

释    义   n. [内科] 酸中毒,酸毒症;酸液过多症

例    句   Shock , sepsis, acidosis , hypoxia, and so forth, are treated. 对休克,感染,酸中毒,缺氧等应加以治疗。

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