日常门诊中，浙江省人民医院内分泌科副主任医师黄青华经常会遇到一些想减肥的患者，要求开司美格鲁肽。

“我们遇到过一些患者，自行通过一些渠道购买药物后自行注射，最后出现问题。” 黄青华说。

曾经有20多岁的女孩，买了司美格鲁肽后，为了追求减肥效果，直接注射1mg，出现剧烈的恶心、呕吐，一度呕吐到脱水，被紧急送到医院急诊室抢救。

“在国内，司美格鲁肽的适应症是血糖控制不佳或者有心血管疾病的成人2型糖尿病患者，作为处方药，在使用前，我们是要对患者进行相关检查。”

这样的检查包括血糖、血脂、血尿酸、血压、糖化血红蛋白、肝肾功能、胰岛功能、胰腺炎检测、降钙素、肥胖相关激素、心电图以及甲状腺和肝脏B超等。

黄青华解释，司美格鲁肽注射后，药物主要是通过肝肾代谢，所以要检查肝肾功能是否正常，以免出现不良后果。产期注射司美格鲁肽会增加胰腺炎和甲状腺髓样癌的风险，所以我们需要排查药物禁忌。司美格鲁肽也可能会引起心率、血压异常，因此需要进行心率血压评估。肥胖人群我们也需要检查肥胖相关激素排查继发性肥胖及肥胖导致的代谢紊乱。（潮新闻 记者 吴朝香）

实际上，司美格鲁肽的使用注射要循序渐进，逐渐加量。

“临床上，如果患者具有适应症，第一次，我们一般注射0.25mg 一周一次，看患者在一周内是否有恶心呕吐等胃肠道反应，以及降糖减重效果，如果反应不明显可逐渐增加到0.5mg 一周一次，一般剂量可以打到1mg 一周一次。如果是减重，一般达到理想的体重或者处于体重瓶颈期了，就可以停止注射；但它本身时一个降糖药物，糖尿病患者是可以长期使用的。” 黄青华表示。

作为药物，司美格鲁肽虽然减重效果可喜，但也伴随着相应的副作用：恶心、呕吐、腹泻等肠胃不适，另外，动物试验中发现司美格鲁肽会刺激甲状腺C细胞增生，所以该药禁用于有甲状腺髓样癌的患者，同时因为会诱发胰腺癌等，甘油三酯高的人群也不建议使用。

“一些年轻女孩本身挺瘦的，但为了追求上镜等效果，也会提出打针，这些我们都是拒绝的。”作为内分泌科医生，黄青华不建议患者自行购药、自行使用，“一定要到医院，经过专业医生的评估。”

今年初初，司美格鲁肽出现口服型，和注射针剂相比，它更方便，可以预见，如果滥用这一类的药物会出现很多问题。

“口服剂还没进入医院，但已经有患者来咨询了。”黄青华说，虽然司美格鲁减重效果明显，但它并非一劳永逸，即便是适应症患者，在停药后也会出现体重反弹。

在社交平台上，有不少网友分享自己的经历：根本停不下来，打一年了，一停就反弹；打了8个月，瘦了20斤，管不住嘴又不运动，瘦不下来了；打了10个月，减了35斤，停了快2个月，增加了10多斤……

在黄青华看来，大家对司美格鲁肽的狂热追捧，归根结底还是对减重的焦虑，以及不当认知。

潮新闻·钱江晚报健康小站、杭州拱墅区文晖社区卫生服务中心副主任朱秋静对此深有同感，“很多要打这个针的患者其实不是糖尿病，血糖血脂也没有异常，就是想减重，或者觉得自己不够瘦，想快速变瘦。”

“从减重的角度看，所谓的‘减肥神药’也只是辅助手段，减重首先要找到肥胖的根源，然后对症治疗。” 临床中，黄青华接诊过许多减重不当而自伤的患者，比如过度节食导致月经不调，甚至出现抑郁等精神问题。（潮新闻 记者 吴朝香）

（来源：钱江晚报）

新闻译文：

In daily outpatient clinics, Huang Qinghua, the deputy chief physician of the endocrinology department at Zhejiang Provincial People's Hospital, often encounters patients who want to lose weight and requests to prescribe smectide.

"We have encountered some patients who purchased medication through various channels and injected it themselves, but eventually encountered problems," said Huang Qinghua.

There was once a girl in her twenties who, after buying Smegglutide, injected 1mg directly in pursuit of weight loss effects. She experienced severe nausea and vomiting, which eventually led to dehydration. She was urgently sent to the emergency room of the hospital for treatment.

"In China, the indication of smeglutide is adult type 2 diabetes patients with poor blood glucose control or cardiovascular disease. As a prescription drug, we need to conduct relevant examinations on patients before use."

This type of examination includes blood glucose, blood lipids, blood uric acid, blood pressure, glycated hemoglobin, liver and kidney function, pancreatic function, pancreatitis detection, calcitonin, obesity related hormones, electrocardiogram, and thyroid and liver ultrasound.

Huang Qinghua explained that after injection, the drug mainly passes through liver and kidney metabolism, so it is necessary to check whether liver and kidney function is normal to avoid adverse consequences. Injecting smeglutide during childbirth increases the risk of pancreatitis and medullary thyroid cancer, so we need to investigate drug contraindications. Smegglutide may also cause abnormalities in heart rate and blood pressure, therefore a heart rate and blood pressure assessment is necessary. We also need to examine obesity related hormones in obese individuals to identify secondary obesity and metabolic disorders caused by obesity. (Chao News reporter Wu Chaoxiang)

In fact, the use of Smegglutide injection should be gradual and gradually increased in dosage.

In clinical practice, if a patient has indications, we usually inject 0.25mg once a week for the first time to see if the patient has gastrointestinal reactions such as nausea and vomiting, as well as the effect of blood sugar and weight loss within a week. If the reaction is not obvious, it can gradually increase to 0.5mg once a week, and the general dose can be administered up to 1mg once a week. If weight loss is achieved, the injection can generally be stopped when the ideal weight is reached or the weight bottleneck period is reached; But it is a hypoglycemic drug in itself, and diabetes patients can use it for a long time. " Huang Qinghua said.

As a drug, smeglutide, although its weight loss effect is gratifying, also has corresponding side effects: nausea, vomiting, diarrhea and other gastrointestinal discomfort. In addition, it was found in animal tests that smeglutide can stimulate the proliferation of thyroid C cells, so this drug is prohibited for patients with medullary thyroid cancer. At the same time, because it can induce pancreatic cancer, people with high triglycerides are also not recommended to use it.

"Some young girls are quite thin themselves, but in order to pursue effects such as getting on the camera, they also propose injections, which we refuse. As an endocrinologist, Huang Qinghua does not recommend patients to purchase medication or use it on their own." Be sure to go to the hospital and undergo evaluation by a professional doctor. "

At the beginning of this year, Smegglutide appeared in oral form, which is more convenient than injection. It can be foreseen that there will be many problems if this type of drug is abused.

"The oral medication has not yet entered the hospital, but patients have already come to consult," Huang Qinghua said. Although Smeglu has a significant weight loss effect, it is not a one-time solution. Even patients with indications may experience weight rebound after discontinuing the medication.

On social media platforms, many netizens share their experiences: they can't stop playing at all, they've been playing for a year, and when they stop, they rebound; I have been playing for 8 months and lost 20 pounds. I can't control my mouth and don't exercise, so I can't lose weight anymore; Played for 10 months, lost 35 pounds, stopped for almost 2 months, and increased by more than 10 pounds

In Huang Qinghua's view, the fanatical pursuit of Smegglutide ultimately stems from anxiety about weight loss and improper cognition.

Zhu Qiujing, the health station of Chaoxin Qianjiang Evening News, and the deputy director of Wenhui community Health Service center in Gongshu District, Hangzhou, shared this feeling. "Many patients who want to get this injection are not diabetes, and their blood sugar and lipids are not abnormal. They just want to lose weight, or feel they are not thin enough, and want to lose weight quickly."

"From the perspective of weight loss, the so-called 'weight loss elixir' is only an auxiliary means. Weight loss first requires identifying the root cause of obesity and then treating it accordingly." In clinical practice, Huang Qinghua has treated many patients who suffered from self harm due to improper weight loss, such as excessive dieting leading to menstrual irregularities, and even mental problems such as depression. (Chao News reporter Wu Chaoxiang)

(Source: Qianjiang Evening News)

重点词汇

• 人民医院 peoples hospital ; Hospital

• 内分泌科 Endocrinology ; department of endocrinology ; endocrine ; Endocrinology Department

• 副主任 deputy director ; vice minister (of a commission of the central government)

• 出现问题 go wrong ; problems

• 在国内 Domestic ; at home ; go home

• 适应症 indication

• 心血管疾病 cardiovascular disease

• 糖尿病患者 diabetic

• 在使用 in use

• 相关检查 Relevant inspection ; dependency check

句子成分分析：

[On social media platforms], many netizens share their experiences: they can't stop playing [at all], || they've been 

playing for a year, || and when they stop, || they rebound;

句子语法结构详解：

(media 为 medium 的复数形式。can't = can not, they've = they have)

* share 为谓语，采用一般现在时。
* 第1个 stop 为谓语。
* 第1个 playing 为动名词，作宾语。
* 第2个 they 开头为陈述句。
* 第2个 playing 为谓语，采用现在完成进行时。
* and 为并列连词。
* when 为连词，引导时间状语从句。
* 第2个 stop 为谓语，采用一般现在时。
* 第4个 they 开头为陈述句。
* rebound 为谓语，采用一般现在时。
* can 为情态动词。they 为人称代词主格。their 为形容词型物主代词。have, been 为助动词。a 为不定冠词。

句子相关词汇解释：

Phrase:

Vocabulary:

句子成分分析：

[At the beginning (of this year)], Smegglutide appeared [in oral form, (which is more convenient [than injection])].

句子语法结构详解：

* appeared 为谓语，采用一般过去时。
* which 为关系代词，引导非限制性定语从句。
* is 为系动词作谓语，采用一般现在时。
* convenient 为形容词作表语。
* the 为定冠词。

句子相关词汇解释：

Phrase:

Vocabulary:

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