吉非替尼致间质性肺炎并文献回顾  

Interstitial pneumonia induced by gefitinib induced and literature review

作　　者：罗长琴[1] 王丽娜[1] 李雨遥[1] 吕美玲[1] 周小娟[1] 田涛[1] 杨谨[1] 

机构地区：[1]西安交通大学医学院第一附属医院肿瘤内科,陕西西安710061

出　　处：《现代肿瘤医学》2012年第9期1858-1862,共5页Journal of Modern Oncology

摘　　要：目的:探讨吉非替尼治疗晚期非小细胞肺癌所致间质性肺炎的临床特点和治疗策略。方法:报告1例吉非替尼治疗晚期非小细胞肺癌所致间质性肺炎的临床资料,并进行系统文献回顾,对吉非替尼所致间质性肺炎的临床特点,机理和治疗进行分析。结果:综合本病例患者特点和国内外文献分析,老年男性、长期吸烟史、吸烟指数高、腺癌、特别是细支气管肺泡癌患者在服用吉非替尼期间更容易发生间质性肺炎,发生时间多在服药后1-2月,临床表现以胸闷、气短、进行性呼吸困难为特点,伴有严重低氧血症,甚至呼吸衰竭。影像学检查以双肺弥漫性浸润性阴影及蜂窝状间质改变为代表,及时判断病因并停药,给予糖皮质激素、吸氧、抗感染等对症处理可缓解。结论:一旦发现吉非替尼所致的间质性肺炎应及时停药,大多数患者病情可缓解,早期可控制的间质性肺炎,不是永久停用吉非替尼的绝对指标,应根据患者的获益和药物治疗相关风险综合考虑。Objective：To explore the clinical characteristics and treatment strategies of interstitial pneumonia in-duced by gefitinib for patients with advanced non - small cell lung cancer （NSCLC）. Methods ： The detailed clinical data of one NSCLC patient with interstitial pneumonia induced by gefitinib was reported. The case report and review a-bout interstitial pneumonia induced by gefitinib for patients with NSCLC were reviewed. Clinical characteristics, mech- anism and treatment strategies of this rare disease were analyzed. Results： Characteristics of this patient with intersti-tial pneumonia, domestic and foreign literature were analyzed. Old, male patients with long smoking history , high smoking index and adenocarcinoma（ especially the bronchoalveolar carcinoma） are more likely to occured interstitial pneumonia during takeing gefitinib. The onset time of gefitinib - induced interstitial pneumonia is about 1 - 2 months. The clinical manifestations are chest tightness, shortness of breath, progressive dyspnea, severe hypoxemia, and even respiratory failure. Diffuse infiltration shadow and alveolar interstitial shadow can be seen on chest tomography. Timely judgement and gefitinib withdrawal should be applied. High - dose glucocorticoid, oxygen inhalation therapy, and anti -infective therapy should be administered. Conclusion： Once interstitial pneumonia induced by gefitinib occured, ge-fitinib should be timely discontinued. Most patients should be alleviated. The early interstitial pneumonia is not an ab-solute index to permanent discontinuation of gefitinib. Benefit and hazard of this drug for patients should be compre- hensively considered.

关 键 词：吉非替尼 间质性肺炎 糖皮质激素 

分 类 号：R730.53[医药卫生—肿瘤]