帕博利珠单抗致免疫相关性肺炎1例  

A case of immune-associated pneumonia caused by pembrolizumab

作　　者：汪星辉[1] 胡娟[1] 王凤玲[1] 戴丽[1] 孟祥云[1] WANG Xing-hui;HU Juan;WANG Feng-ling;DAI Li;MENG Xiang-yun(Department of Pharmacy,the Second People's Hospital of Hefei/Hefei Hospital Affiliated to Anhui Medical University,Hefei 230011,China)

机构地区：[1]合肥市第二人民医院/安徽医科大学附属合肥医院药学部,安徽合肥230011

出　　处：《中国药物应用与监测》2022年第2期129-132,共4页Chinese Journal of Drug Application and Monitoring

基　　金：国家自然科学基金资助项目(82003849);合肥市医学重点学科建设资助项目[合卫科教(2019)160]。

摘　　要：1例60岁男性患者,诊断为“右肺腺癌伴淋巴结转移”。2020年12月22日予培美曲塞+卡铂化疗,2021年1月17日在原有化疗方案基础上联合帕博利珠单抗(200 mg,q 3 w,ivgtt)进行2个周期免疫治疗。3月12日患者出现胸闷气喘、咳嗽咳痰伴发热,胸部CT示两肺多发斑片影及磨玻璃影,考虑为帕博利珠单抗所致免疫相关性肺炎,给予糖皮质激素治疗5 d后,患者症状显著改善,炎性渗出明显吸收,出院后序贯泼尼松巩固治疗。停用糖皮质激素2周后,患者再次出现相同症状,考虑免疫相关性肺炎复发,经糖皮质激素治疗后症状改善,CT复查示右肺多发磨玻璃影已显示不清,两侧胸腔积液基本吸收。后予紫杉醇+奈达铂维持化疗,患者病情稳定,未再出现肺部炎症。A 60-year-old male patient was diagnosed with right lung adenocarcinoma with lymph node metastasis.Pemetrexed+carboplatin chemotherapy was given on December 22^(nd),2020,and pembrolizumab(200 mg,q 3 w,ivgtt)was combined with the original chemotherapy regimen for two cycles of immunotherapy on January 17^(th),2021.On March 12^(th),he developed chest tightness and asthma,cough and expectoration with fever,and chest CT showed multiple patchy shadows and ground glass shadows in both lungs,which was considered as the high possibility of immune-related pneumonia caused by pembrolizumab.After 5 days treatment of glucocorticoid,his symptoms significantly improved and the inflammatory exudation was significantly absorbed.And prednisone was continued after discharge.2 weeks after glucocorticoid withdrawal,he developed the same symptoms again,which indicated the recurrence of immune-related pneumonia,and the symptoms were significantly improved after glucocorticoid treatment.CT reexamination showed that multiple ground glass shadows in the right lung were significantly improved,and pleural effusion on both sides was basically absorbed.After that,maintenance chemotherapy with paclitaxel and nedaplatin was given to him.After that,his condition was stable without pulmonary inflammation.

关 键 词：免疫相关性肺炎 帕博利珠单抗 糖皮质激素 药品不良反应 

分 类 号：R969.3[医药卫生—药理学] R979.1[医药卫生—药学]