# 一位60歲患有第二型糖尿病的個案，新開立sitagliptin 100毫克每日一次口服。個案哪一項陳述顯示出正確的理解？

> source: MyMerci (mymerci.kr)  
> url: https://mymerci.kr/pages/nclex_q.php?qn_id=375083&lang=zh-tw  
> language: zh-TW  
> subject: Medical Emergencies  
> category: PA

## 題目

一位60歲患有第二型糖尿病的個案，新開立sitagliptin 100毫克每日一次口服。個案哪一項陳述顯示出正確的理解？

## 選項

1. 若早上BG正常·我會跳過該劑量。
2. 我會回報放射至背的劇烈腹痛·持續噁心·新發關節痛 — 這可能表示這個DPP-4 inhibitor的胰臟炎或其他副作用。 **✔ 正確答案**
3. sitagliptin會引起嚴重低血糖·我會每小時測BG。
4. 為加速吸收我會嚼碎sitagliptin錠劑。

**正確答案: 2**

## 解析

DPP-4抑制劑 — 病人衛教
DPP-4抑制劑（gliptins類）：sitagliptin (Januvia)、saxagliptin (Onglyza)、linagliptin (Tradjenta)、alogliptin。作用機轉：抑制二肽基肽酶-4 → 延長內源性腸促胰島素（GLP-1、GIP）的作用 → 葡萄糖依賴性胰島素分泌 + 減少昇糖素。通常耐受性良好；一般每日一次口服。

關鍵衛教：
• 單一療法時低血糖風險低（葡萄糖依賴性作用）。不需常規每小時監測；只需標準自我血糖監測和糖化血色素追蹤。
• 胰臟炎（罕見但需通報）：嚴重腹痛放射至背部、持續噁心/嘔吐 — 停藥並通知醫師。
• 嚴重關節痛 — 類別警告；可能在開始用藥後數週至數年發生；停藥後通常緩解。
• 心衰竭：saxagliptin和alogliptin與心衰竭住院相關 — 心衰竭病人需謹慎。
• 腎功能劑量調整：sitagliptin在肌酸酐清除率

## 深入解析

為何選2
DPP-4 inhibitor(gliptin):sitagliptin·saxagliptin·linagliptin·alogliptin。機制:抑制DPP-4 → 延長內生性incretin(GLP-1·GIP)作用 → glucose-dependent胰島素分泌·降glucagon。

衛教重點
• 單獨monotherapy hypoglycemia風險低(glucose-dependent)。每小時檢測不需·標準SMBG/A1c追蹤。
• 胰臟炎(罕但需報告):嚴重腹痛·背放射·持續噁心/嘔吐 → 停藥·通報醫師。
• 嚴重關節痛:class warning·開始後數週~數年·停藥通常改善。
• 心衰竭:saxagliptin·alogliptin有HF住院風險·HF個案注意。
• 腎不全劑量:sitagliptin CrCl

## 重要概念

- **Sitagliptin** — Januvia·DPP-4 inhibitor·incretin enhancer。100 mg QD·每日1次。T2DM輔助。副作用:鼻咽炎·頭痛·單獨hypoglycemia少·胰臟炎(罕)·關節痛(class warning)。腎不全須調劑量。T1DM禁忌。
- **Incretin效應** — GLP-1·GIP於進食時自腸道分泌·刺激胰島素·抑glucagon·延遲胃排空·抑制食慾。T2DM中incretin效應降·以DPP-4 inhibitor·GLP-1 agonist強化。Glucose-dependent作用·hypoglycemia風險低。
- **T2DM藥物hypoglycemia風險** — 高:胰島素·sulfonylurea(glipizide·glyburide)·meglitinide(repaglinide)。低:metformin·DPP-4 inhibitor·SGLT-2·GLP-1·thiazolidinedione(pioglitazone)·alpha-glucosidase。合併使用風險疊加。

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