警惕肿瘤免疫治疗的内分泌系统不良反应  

Be aware of endocrinological side effects of cancer immunotherapy

作　　者：方晨 郭鹤鸣 黄韵[1] 陈小红[1] 李思诚 刘翠平 胡吉[1] Fang Chen;Guo Heming;Huang Yun;Chen Xiaohong;Li Sicheng;Liu Cuiping;Hu Ji(Department of Endocrinology,The Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Jiangsu Institute of Clinical Immunology,Suzhou 215000,China)

机构地区：[1]苏州大学附属第二医院内分泌科,215004 [2]江苏省临床免疫研究所,苏州215000

出　　处：《国际内分泌代谢杂志》2019年第5期327-331,336,共6页International Journal of Endocrinology and Metabolism

基　　金：国家自然科学基金(81600607);江苏省研究生科研与实践创新计划项目(SJCX18_0854).

摘　　要：肿瘤免疫治疗中免疫检查点抑制剂(ICPi)已广泛应用于临床,它们通过阻断抑制T细胞功能的负调节因子来增强抗肿瘤作用.细胞毒性T淋巴细胞相关抗原-4(CTLA-4)抑制剂和程序性细胞死亡蛋白-1(PD-1)抑制剂的应用已经显著改善了一些晚期恶性肿瘤的预后,但也导致多种自身免疫性不良反应.内分泌疾病包括甲状腺功能紊乱、自身免疫性糖尿病和垂体炎等,已成为ICPi治疗中最常见的免疫相关不良事件之一.这些内分泌系统不良反应若不能及时发现和治疗,会影响患者治疗甚至危及生命.了解ICPi治疗相关性内分泌系统不良反应的临床特点、诊断及治疗,可增进临床医师在免疫治疗中对该类不良反应的认识.In cancer immunotherapy, immune checkpoint inhibitors ( ICPi) have been widely used. They enhance antitumour immunity by blocking negative regulators of T cell function. Cytotoxic T lymphocyte antigen-4 (CTLA-4) and programmed cell death protein-1 (PD-1) inhibitors have dramatically changed the outcome of patients with several advanced stage malignancies, but they also lead to a variety of autoimmune consequences. Endocrinopathies have emerged as one of the most common immune-related adverse events ( irAEs) of ICPi therapy including thyroid dysfunction, autoimmune diabetes and hypophysitis, etc. These endocrinological side effects can affect the tumor treatment even be life-threatening if not promptly recognized and treated. Knowing the clinical characteristics, diagnosis and treatment of various ICPi related adverse re-actions of endocrine system could enhance clinicians′ understanding of these adverse reactions in immuno-therapy.

关 键 词：免疫检查点抑制剂 内分泌疾病 细胞毒性T淋巴细胞相关抗原-4 程序性细胞死亡蛋白-1 

分 类 号：R730.51[医药卫生—肿瘤]