肺癌免疫检查点抑制剂相关性肺炎的临床特征及CT征象分析  

Analysis of clinical and CT features of checkpoint inhibitor pneumonitis in patients with lung cancer

作　　者：杜永浩[1] 张丹丹[2] JULIEN Michael Paxon 贾晓慧 李彦霖 郭卉[3] 牛刚[1] 梁挺[1] DU Yonghao;ZHANG Dandan;JULIEN Michael Paxon;JIA Xiaohui;LI Yanlin;GUO Hui;NIU Gang;LIANG Ting(Department of Radiology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Outpatient,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China;Department of Oncology,the First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)

机构地区：[1]西安交通大学第一附属医院影像科,陕西西安710061 [2]西安交通大学第一附属医院门诊部,陕西西安710061 [3]西安交通大学第一附属医院肿瘤内科,陕西西安710061

出　　处：《实用放射学杂志》2022年第10期1590-1593,共4页Journal of Practical Radiology

基　　金：陕西省重点研发计划项目(2020SF-104);陕西省自然科学基金项目(2020JQ-518);西安交通大学第一附属医院科研发展基金项目(2021ZYTS-22);西安交通大学第一附属医院临床研究课题(XJTU1AF2021CRF-015)。

摘　　要：目的探讨肺癌患者免疫检查点抑制剂相关性肺炎(CIP)的临床特点及CT影像学表现。方法回顾性收集接受免疫检查点抑制剂(ICI)治疗而导致CIP患者的临床资料及CT图像,对征象进行总结和分型。结果纳入403例晚期肺癌患者,共51例发生CIP,发生率为12.7%,男女比例约为5:1,年龄29~82岁,中位年龄65岁。CIP患者胸部CT表现为:机化性肺炎(OP)21例,非特异性间质性肺炎(NSIP)13例,过敏性肺炎(HP)4例,急性间质性肺炎(AIP)5例,细支气管炎4例,其他类型4例。CT征象分析:磨玻璃影(GGO)占94.1%,线影及网格影占80.4%,实变占52.9%,牵拉性支气管扩张占43.1%,树芽征占7.8%,小叶中心结节占9.8%,铺路石征占11.8%,反晕征占5.9%。CIP病变分布特点:胸膜下分布为主占51.0%,混合和多灶性分布占25.5%,弥漫分布占23.5%。对临床分级轻至中度(1~2级)和重度(3~4级)CIP患者的CT表现分析,AIP在2组之间差异有统计学意义(P=0.025),其他CT表现在2组之间无统计学差异(P>0.05)。结论CIP CT表现以OP为主,GGO是最常见的征象,分布多为胸膜下分布;AIP提示临床分级为重度CIP,预后不良。Objective To investigate the clinical features and CT imaging findings of checkpoint inhibitor pneumonitis(CIP)in patients with lung cancer.Methods The clinical data and CT images of patients with CIP caused by immune checkpoint inhibitors(ICI)treatment were collected retrospectively,and the findings were summarized and classified.Results Among 403 patients with advanced lung cancer,51 patients suffered CIP,with an incidence of 12.7%.The male-to-female ratio was about 5:1,with a age 29-82 years,median age of 65 years.The chest CT showed the CIP patterns included organizing pneumonia(OP)in 21 cases,nonspecific interstitial pneumonia(NSIP)in 13 cases,hypersensitivity pneumonia(HP)in 4 cases,acute interstitial pneumonia(AIP)in 5 cases,bronchiolitis in 4 cases and other types in 4 cases.On CT features,the CIP appeared as ground-glass opacity(GGO)in 94.1%,line shadow and grid shadow in 80.4%,solid in 52.9%,tractive bronchiectasis in 43.1%,tree in bud sign in 7.8%,central lobular nodule in 9.8%,crazy-paving sign in 11.8%,and reversed halo sign in 5.9%.The distribution of CIP lesions included subpleural area in 51.0%,mixed and multifocal area in 25.5%,and diffuse area in 23.5%.Between mild to moderate(grade 1-2)and severe(grade 3-4)CIP patients in the clinic,there was a significant difference in AIP pattern on CT(P=0.025),however no significant differences in other CT patterns were found(P>0.05).ConclusionThe main CT features of CIP is the OP pattern,and GGO is the most common sign,which is mostly distribute at subpleural area.AIP pattern may indicate severe CIP in the clinic and poor prognosis.

关 键 词：肺癌 免疫检查点抑制剂相关性肺炎 计算机体层成像 

分 类 号：R734.2[医药卫生—肿瘤] R563.1[医药卫生—临床医学] R814.42