程序性死亡受体1（programmed death 1， PD-1）抑制剂是免疫检查点抑制剂（immune checkpoint inhibitors， ICI）的一种，在肿瘤治疗中应用广泛，但易引发免疫相关不良事件，其中暴发性1型糖尿病酮症酸中毒（diabetic ketoacidosis， DKA）较为罕见。2025年2月，检索PubMed总共报道了59例ICI相关暴发性1型糖尿病DKA病例，男性31例，女性28例；中位发病年龄61岁（14~87岁），主要原发病种为黑色素瘤（27.1%）和非小细胞肺癌（18.6%）；治疗药物中PD-1单抗占比最高（67.8%），其中应用帕博利珠单抗18例，纳武利尤单抗17例。本文报道1例胃窦恶性肿瘤患者应用PD-1抑制剂替雷利珠单抗后，出现暴发性1型糖尿病DKA的病例。目前认为，其发病机制可能与免疫系统异常激活有关，诊断主要依据临床症状及体征、实验室检查和相关病史。对于正在接受PD-1抑制剂治疗的肿瘤患者，短期内血糖迅速升高、出现DKA症状，在排除其他常见糖尿病病因后应高度警惕该病。治疗方面，及时补液、消酮，短期胰岛素治疗和积极对症处理是关键。ICI相关糖尿病并非PD-1抑制剂治疗的绝对禁忌证，待患者病情稳定后，可在密切监测下继续使用。本例患者诊断及时、准确，经胰岛素治疗后血糖控制良好，出院后在严密监测下继续使用PD-1抑制剂。本例报道为临床提供了经验，提醒临床医生在使用PD-1抑制剂时，除监测甲状腺和垂体功能外，需同步监测血糖波动，重视多学科协作，以避免发生糖尿病急性并发症的严重后果。

Programmed death receptor 1 (PD-1) inhibitors are a type of immune checkpoint inhibitors (ICI), which are widely used in cancer therapy, but can easily trigger immune-related adverse events, among which fulminant type 1 diabetic ketoacidosis (DKA) is relatively rare. As of February 2025, a search was conducted on PubMed, and a total of 59 cases of fulminant type 1 diabetes ketoacidosis (DKA) induced by ICI with complete data were summarized, including 31 males and 28 females. The median age at onset was 61 years (range: 14-87 years), and the primary tumors were mainly melanoma (27.1%) and non-small cell lung cancer (18.6%). Among the therapeutic agents, PD-1 monoclonal antibodies account for the highest proportion (67.8%), with pembrolizumab (18 cases) and nivolumab (17 cases). This paper reports a case of fulminant type 1 diabetic ketoacidosis in a patient with malignant gastric antrum tumor after treatment with the PD-1 inhibitor tirelizumab. At present, it is believed that its pathogenesis may be related to abnormal activation of the immune system. Diagnosis is mainly based on clinical symptoms and signs, laboratory tests, and relevant medical history. For cancer patients receiving PD-1 inhibitor therapy, a rapid rise in blood glucose and the onset of DKA symptoms in the short term should raise a high level of concern for this condition after excluding other common causes of diabetes. In terms of treatment, timely fluid resuscitation, ketone clearance, short-term insulin therapy, and active symptomatic management are crucial. ICI-related diabetes is not an absolute contraindication for PD-1 inhibitor therapy. Once the patient's condition stabilizes, it can be continued under close monitoring. In this case, this patient was diagnosed timely and accurately. After insulin therapy, blood glucose was well controlled. PD-1 inhibitors could be continued under strict monitoring after discharge. This case report provides clinical experience, reminding clinicians that when using PD-1 inhibitors, in addition to monitoring thyroid and pituitary function, blood glucose fluctuations should be monitored simultaneously, and multidisciplinary collaboration should be emphasized to avoid serious consequences of acute complications of diabetes.