替尔泊肽诱导的肠壁囊样积气症：一种罕见但具有临床意义的胃肠道不良反应

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中文摘要

目的： 胰高血糖素样肽-1受体激动剂如替尔泊肽越来越多地被用于治疗2型糖尿病和肥胖，因为它们能改善血糖控制并促进体重减轻。尽管恶心、呕吐、便秘和胃排空延迟等胃肠道不良反应已被充分认识，但该类药物的极罕见肠壁囊样积气症病例也有报道。我们报告首例经组织学诊断的可能与替尔泊肽相关的肠壁囊样积气症。
方法： 一名55岁男性，患有肥胖、2型糖尿病、高血压和阻塞性睡眠呼吸暂停，因腹痛、便秘和肛裂接受结肠镜检查。他接受替尔泊肽治疗约1年，体重减轻了49磅。结肠镜检查显示盲肠和升结肠黏膜水肿。
结果： 结肠活检标本显示黏膜和黏膜下含气腔隙，伴有异物型巨细胞反应和混合性炎症细胞浸润，包括嗜酸性粒细胞和中性粒细胞，符合肠壁囊样积气症。该患者缺乏其他公认的肠壁囊样积气症危险因素，停用替尔泊肽后症状改善。
结论： 随着替尔泊肽及相关胰高血糖素样肽-1受体激动剂的使用持续增加，对该罕见副作用及其特征性组织学表现的认识应有助于及时识别和准确诊断。报告这些罕见事件对于完善这些日益广泛使用的药物的安全性特征，并增进我们对其在更广泛患者群体中长期胃肠道影响的理解，仍然至关重要。

英文摘要

OBJECTIVES: Glucagon-like peptide 1 receptor agonists such as tirzepatide are increasingly prescribed to treat type 2 diabetes mellitus and obesity because they improve glycemic control and promote weight loss. Although gastrointestinal adverse effects such as nausea, vomiting, constipation, and delayed gastric emptying are well recognized, very rare cases of pneumatosis intestinalis have also been reported in association with this class of medications. We report the first documented histologic diagnosis of a possible tirzepatide-associated pneumatosis intestinalis.
METHODS: A 55-year-old man with obesity, type 2 diabetes mellitus, hypertension, and obstructive sleep apnea underwent colonoscopy for evaluation of abdominal pain, constipation, and anal fissures. He had been receiving tirzepatide therapy for approximately 1 year and experienced a 49-pound weight loss. Colonoscopy demonstrated mucosal edema of the cecum and ascending colon.
RESULTS: Biopsy specimens of the colon revealed mucosal and submucosal air-filled spaces associated with foreign body-type giant cell reactions and mixed inflammatory infiltrates, including eosinophils and neutrophils, consistent with pneumatosis intestinalis. The patient lacked other recognized risk factors for pneumatosis intestinalis, and his symptoms improved following discontinuation of tirzepatide.
CONCLUSIONS: As the use of tirzepatide and related glucagon-like peptide 1 receptor agonists continues to increase, awareness of this rare side effect and its characteristic histologic features should facilitate prompt recognition and accurate diagnosis. Reporting these rare events remains essential to refine the safety profile of these increasingly used medications and improve our understanding of their long-term gastrointestinal effects in broader patient populations.