卡瑞利珠单抗致牙龈及唇化脓性肉芽肿1例报道及文献回顾  

Pyogenic granuloma of the gums and lips caused by camrelizumab: case report and literature review

作　　者：李蕴喆 卜令学[1] 庞宝兴[1] 王烨 刘风芝[1] 杨楠[1] 陈晨[1] 王双义[1] LI Yun-zhe;BU Lingxue;PANG Baoxing;WANG Ye;LIU Fengzhi;YANG Nan;CHEN Chen;WANG Shuangyi(Stoma-tology Center of Affiliated Hospital of Qingdao University,School of Stomatology of Qingdao University,Qingdao Stomato-logical Digital Medicine and 3D Printing Engineering Laboratory,Qingdao 266003,China;Department of Pathology of Affiliated Hospital of Qingdao University,Qingdao 266003,China)

机构地区：[1]青岛大学附属医院口腔医学中心,青岛大学口腔医学院,青岛市口腔数字医学与3D打印工程实验室,山东青岛266003 [2]青岛大学附属医院病理科,山东青岛266003

出　　处：《口腔疾病防治》2023年第3期197-201,共5页Journal of Prevention and Treatment for Stomatological Diseases

基　　金：山东省自然科学基金项目(ZR2017BH034)。

摘　　要：目的 探讨卡瑞利珠单抗致口腔颌面部化脓性肉芽肿的临床表现、病理特征及治疗。方法 报道1例卡瑞利珠单抗致牙龈及唇化脓性肉芽肿病例并结合文献进行系统性回顾分析。结果 患者使用卡瑞利珠单抗治疗肝癌4个月后,出现全身反应性毛细血管增生症(reactive capillary hemangiomas,RCH),随后出现下唇及牙龈多发肿物,患者行牙周基础治疗后,切除下唇及牙龈肿物并停用卡瑞利珠单抗,病理结果为牙龈化脓性肉芽肿/肉芽肿型血管瘤,术后随访口腔内未见新生肿物。文献回顾表明,RCH是卡瑞利珠单抗最常见的药物不良反应,发生于口腔者较少。目前尚未明确RCH病因,有研究表明卡瑞利珠单抗可能通过激活血管内皮细胞使其增殖为血管瘤;联合使用卡瑞利珠单抗安全性优于单用;RCH有自限性,大多数停药后可自行消退;若肿物引起功能障碍,可行手术切除。结论 卡瑞利珠单抗可致口腔颌面部反应性毛细血管增生症并发化脓性肉芽肿。Objective To investigate the clinical manifestations, pathological features, and treatment of oral and maxillofacial pyogenic granulomas induced by camrelizumab.Methods A case of pyogenic granuloma of the gums and lips caused by camrelizumab was reported along with a literature review.Results After 4 months of treatment with camrelizumab for liver cancer, the patient developed systemic reactive capillary hyperplasia(RCH), followed by multiple masses on the lower lip and gingiva. After periodontal therapy, the masses on the lower lip and the gingiva were removed,and camrelizumab administration was stopped. The pathological result was gingival pyogenic granuloma/granulomatous hemangioma. No new masses were found in the oral cavity during postoperative follow-up. A review of the literature showed that RCH is the most common adverse drug reaction to camrelizumab but it occurs infrequently in the oral cavity.At present, the etiology of RCH has not been clarified, but the research has shown that camrelizumab may trigger tissue proliferation into hemangiomas by activating vascular endothelial cells, and the combined use of camrelizumab is safer than single use. RCH is self-limiting and most cases resolve spontaneously after discontinuation of the drug. If the mass causes dysfunction, surgical excision is feasible.Conclusion Camrelizumab can cause oral and maxillofacial reactive capillary hyperplasia complicated by pyogenic granuloma.

关 键 词：卡瑞利珠单抗 程序性细胞死亡受体-1 恶性肿瘤 免疫治疗 药物不良反应 口腔 反应性毛细血管增生症 血管瘤 血管内皮细胞 化脓性肉芽肿 

分 类 号：R78[医药卫生—口腔医学]