纳武利尤单抗致重度溃疡性结肠炎  

Nivolumab‑induced severe ulcerative colitis

作　　者：梁瑜[1] 孟真[1] 刘东华[1] 仓怀芹[1] 纪洪艳 杨雪[1] 全香花[1] Liang Yu;Meng Zhen;Liu Donghua;Cang Huaiqin;Ji Hongyan;Yang Xue;Quan Xianghua(Department of Pharmacy,the Affiliated Hospital of Qingdao University,Shandong Province,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院药学部,青岛266003

出　　处：《药物不良反应杂志》2022年第3期159-161,共3页Adverse Drug Reactions Journal

基　　金：山东省医学会临床科研专项资金——临床药学应用研究项目(YXH2019ZX010)。

摘　　要：1例64岁男性胃腺癌患者接受奥沙利铂(250 mg静脉滴注、第1天)和替吉奥(60 mg口服、2次/d、第1~14天)方案化疗(21 d为1个治疗周期),1个月后,联合纳武利尤单抗免疫治疗(240 mg静脉滴注、第1天,14 d为1个周期)。纳武利尤单抗第4个周期给药后第2天(首次用药后第44天),患者出现腹泻,呈水样便,3~4次/d,伴轻度腹痛;3 d后腹泻加重,呈暗红色血便,覆脓苔,最多达10次/d,伴明显腹痛。根据肠镜及组织学检查诊断为溃疡性结肠炎(初发型、全结肠、活动期、重度),考虑为纳武利尤单抗所致3级免疫相关性结肠炎。暂停化疗及免疫治疗,给予糖皮质激素、奥曲肽治疗,患者腹痛、腹泻症状逐渐好转。纳武利尤单抗停药后第45天,患者再次接受奥沙利铂+替吉奥化疗,未再出现肠炎症状。A 64‑year‑old male patient with gastric adenocarcinoma received chemotherapy with oxaliplatin(250 mg intravenous infusion on day 1)and tegafur gimeracil oteracil potassium(60 mg orally twice daily on day 1 to day 14,21 days as a cycle).One month later,he was given nivolumab immunotherapy(240 mg intravenous infusion on day 1,14 days as a cycle).On the 2nd day of the 4th cycle of nivolumab treatment(the 44th day after the first dose),the patient developed diarrhea with watery stools,3 to 4 times a day,accompanied by mild abdominal pain;3 days later,the diarrhea worsened,showing dark red bloody stools,covered with pus moss,up to 10 times a day,accompanied by obvious abdominal pain.According to colonoscopy and histological examination results,ulcerative colitis(initial onset,total colon,active stage,and severe)was diagnosed,which was considered as a grade 3 immune‑related colitis induced by nivolumab.After suspension of chemotherapy and immunotherapy,and administration of glucocorticoids and octreotide,the patient′s abdominal pain and diarrhea were gradually improved.On the 45th day of nivolumab withdrawal,the patient received chemotherapy with oxaliplatin and tegafur gimeracil oteracil potassium again,and colitis did not recur.

关 键 词：纳武利尤单抗 溃疡性结肠炎 腹泻 

分 类 号：R969.3[医药卫生—药理学]