一文看懂！使用司美格鲁肽和替尔泊肽前需进行的体检须知

Core Viewpoint - GLP-1 drugs (such as semaglutide and tirzepatide) are recognized for their efficacy in regulating blood sugar and appetite, but they carry serious risks such as thyroid C-cell tumors and acute pancreatitis, necessitating comprehensive pre-treatment evaluations and contraindication screenings [2]. Group 1: Thyroid Function and Imaging Tests - GLP-1 drugs may increase the risk of medullary thyroid carcinoma (MTC), requiring thyroid function tests (including serum calcitonin and thyroid hormone levels) and thyroid ultrasound for assessment [3]. - If serum calcitonin exceeds 100 pg/mL, MTC risk should be considered, but imaging tests are needed for comprehensive evaluation [3]. - Patients with a history of MTC or multiple endocrine neoplasia syndrome type 2 (MEN 2) should not use these drugs, while those with benign thyroid nodules can use them with regular monitoring [5][6]. Group 2: Pancreatitis Risk Assessment - The likelihood of developing pancreatitis is 9.1 times higher in patients using semaglutide, although the actual incidence remains low [7]. - Patients with a history of pancreatitis should avoid these drugs, and if symptoms like persistent abdominal pain or elevated amylase/lipase occur, immediate medical attention is required [9]. Group 3: Renal Function Assessment - Semaglutide is eliminated 70% through the kidneys, while tirzepatide is about 30%, allowing for more lenient restrictions in patients with renal impairment [10]. - Renal function must be assessed through blood creatinine, urea nitrogen, and creatinine clearance (Ccr), with semaglutide contraindicated for Ccr <30 mL/min [10]. Group 4: Cardiac Function Evaluation - Semaglutide may cause a slight increase in heart rate (average increase of 3-5 beats per minute), necessitating cardiac function assessments [11]. - Evaluations should include electrocardiograms (ECG) and echocardiograms to check for arrhythmias and left ventricular ejection fraction (LVEF) [11]. Group 5: Routine Physical and Laboratory Examinations - Routine checks are required for patients using semaglutide and tirzepatide, including weight and body composition assessments [12]. - Metabolic indicators such as fasting blood glucose, HbA1c, liver function (ALT, AST), and lipid profiles (total cholesterol, HDL-C, LDL-C) should be monitored [14]. Group 6: Contraindications - Patients with a history of MTC or MEN 2 are explicitly prohibited from using these drugs due to potential tumor progression risks [15]. - Individuals with a history of pancreatitis must avoid these medications, ensuring triglyceride levels are below 11.3 mmol/L before treatment [15]. - Other contraindications include severe liver and kidney dysfunction, acute gallbladder disease, and severe gastrointestinal disorders [17][18].