免疫检查点抑制剂相关肺炎22例临床特征分析  

Clinical characteristics of immune checkpoint inhibitor⁃related pneumonitis in a 22⁃case series

作　　者：段林立 金川 陈嵘 罗丽红 何梦璋[1] Duan Linli;Jin Chuan;Chen Rong;Luo Lihong;He Mengzhang(Department of Respiratory and Critical Care Medicine,Second Affiliated Hospital of Guangzhou Medical University,Guangzhou 510000,China;Department of Oncology,Affiliated Tumor Hospital of Guangzhou Medical University,Guangzhou 510000,China)

机构地区：[1]广州医科大学附属第二医院呼吸与危重症医学科,广东广州510000 [2]广州医科大学附属肿瘤医院肿瘤科,广东广州510000

出　　处：《广州医科大学学报》2022年第5期12-18,共7页Academic Journal of Guangzhou Medical University

摘　　要：目的:探讨免疫检查点抑制剂相关性肺炎(CIP)的临床特点、影像学、实验室检查及治疗策略。方法:回顾性分析我院22例CIP的诊治过程,记录患者用药史、临床表现、实验室检查、胸部CT表现和治疗及预后情况。结果:22例患者中男性14例,女性8例,年龄(57.09±12.52)岁。合并肺部基础疾病史的有3(13.6%)例。有吸烟史6(27.3%)例。22例发病前均使用了程序性死亡受体1(PD⁃1)抑制剂治疗,但仅2(9.1%)例为单药PD⁃1治疗,其余合并放疗或化疗或靶向药物治疗。主要症状:干咳11(50%)例、咳嗽咳痰5(22.7%)例、乏力8(36.4%)例、发热7(31.8%)例、呼吸困难7(31.8%)例、胸痛1(4.5%)例。实验室检查中白细胞总数(7.9±6.2)∗10^(9)/L,淋巴细胞绝对值下降比例高17(77.3%),常伴有轻中重度贫血18(81.9%)例及血小板下降10(45.5%)例。合并低蛋白血症比例高达94.7%(18/19)。18例患者中分别有9(50%)例、8(44.4%)例合并肌酸激酶及乳酸脱氢酶升高。胸部CT最常见的是双肺弥漫性磨玻璃影10(45.5%)例及网格状间质性肺炎9(41.0%)例的改变。13(59.1%)例患者静脉滴注全身糖皮质激素(1-2 mg/kg·d),3(13.6%)例需要机械辅助通气。17(77.3%)例治疗后好转,2例病情进展,2例死亡,其中1例为再次重启免疫治疗。1例放弃治疗。结论:CIP临床表现缺乏特异性,主要症状为咳嗽、呼吸困难、乏力。胸部CT表现多样,以多发弥漫性磨玻璃影及间质性改变常见,治疗以糖皮质激素为主,预后差,发生CIP后再次重启免疫治疗死亡率高。Objective:To investigate the clinical characteristics,imaging findings,laboratory testing and treatment strategies of immune checkpoint inhibitor⁃related pneumonitis(CIP).Methods:The diagnosis and treatment process of 22 CIP patients admitted to our hospital were retrospectively analyzed.The patients’medication history,clinical manifestations,laboratory testing,chest CT manifestations,treatment and prognosis were recorded.Results:Among the 22 patients,there were 14 males and 8 females,with a mean age of(57.09±12.52)years old.Three patients(13.6%)had a history of underlying pulmonary diseases,and 6(27.3%)had smoking history.Twenty⁃two patients were treated with programmed death receptor⁃1(PD⁃1)inhibitor before onset of CIP,but only 2(9.1%)were treated with PD⁃1 alone,and the rest were treated with PD⁃1 plus radiotherapy/chemotherapy or targeted therapy.The clinical manifestations were non⁃productive cough(n=11,50%),productive cough(n=5,22.7%),fatigue(n=8,36.4%),fever(n=7,31.8%),dyspnea(n=7,31.8%)and chest pain(n=1,4.5%).In the laboratory testing,the total number of white blood cells were(7.9±6.2)∗10^(9)/L;there was a high proportion of cases with declined absolute value of lymphocytes(n=17,77.3%);comorbidity with varying severity of anemia(n=18,81.9%)and thrombocytopenia(n=10,45.5%);comorbidity with hypoproteinemia was found in as high as 94.7%(18/19)of all patients.Among the 18 patients,9(50%)and 8(44.4%)were complicated with elevated creatine kinase and lactate dehydrogenase,respectively.The most common chest CT findings were bilateral diffuse ground⁃glass opacity in 10(45.5%)cases and grid⁃like interstitial pneumonia in 9(41.0%)cases.Thirteen(59.1%)patients received intravenous infusion of systemic glucocorticoids(1-2 mg/kg·d),and 3(13.6%)required mechanically assisted ventilation.Seventeen(77.3%)patients showed improvement after treatment,2 showed disease progression,2 died(including 1 on repeat immunotherapy after CIP),and 1 abandoned treatment.Conclusion:The clinical manifestations o

关 键 词：免疫检查点抑制剂 肺炎 胸部影像学 临床特征 

分 类 号：R563.1[医药卫生—呼吸系统]