免疫检查点抑制剂相关垂体免疫不良反应的诊治  

Immune checkpoint inhibitors induced pituitary immune-related adverse events: diagnosis and management

作　　者：顾阳春[1] 谢超[2] 曹宝山[1] Gu Yangchun;Xie Chao;Cao Baoshan(Department of Medical Oncology and Radiation Sickness,Peking University Third Hospital,Beijing 100191,China;Department of Endocrinology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]北京大学第三医院肿瘤化疗与放射病科,北京100191 [2]北京大学第三医院内分泌科,北京100191

出　　处：《中华肿瘤杂志》2022年第12期1344-1351,共8页Chinese Journal of Oncology

摘　　要：免疫检查点抑制剂已广泛用于多种肿瘤的治疗,激活免疫系统后出现的特殊不良反应尤应引起临床关注。2018年6月程序性死亡受体1(PD-1)抑制剂在中国上市后,已积累了丰富的PD-1及程序性死亡受体配体1(PD-L1)抑制剂相关免疫不良反应(irAE)诊治经验。2021年10月CTLA-4抑制剂获得批准在中国上市,其常见irAE谱与PD-1/PD-L1抑制剂irAE谱存在差异,如垂体irAEs更为常见。垂体irAEs包括垂体炎和垂体功能减退。文章从垂体irAEs的发生率、发生机制、发生时间、临床表现、激素检查、垂体磁共振成像检查、治疗策略和内分泌功能恢复模式等方面进行综述,并结合国内外指南,提出免疫治疗后垂体irAEs的筛查、诊断和治疗建议。Immune checkpoint inhibitors(ICIs)have been used in treating a wide variety of cancers,but they challenge clinicians with a series of special immune related adverse events(irAEs)resulting from activated immune system.Since June 2018,when the first programmed cell death 1(PD-1)inhibitor,nivolumab,was approved by the National Medical Products Administration(NMPA),abundant experience has been accumulated in coping with irAEs from PD-1 and PD-1 ligand 1(PD-L1)blockade therapies.In October 2021,the first CTLA-4 inhibitor,ipilimumab,which has a different spectrum of irAEs was also approved by NMPA.The discrepancy in clinical features of pituitary irAEs is obvious between these two types of ICIs.Pituitary irAEs include hypophysitis and hypopituitarism.In this review of latest literature,we have summarized the incidence,possible mechanisms,time of onset,clinical presentations,hormone test,pituitary imaging,treatment strategies and recovery patterns of pituitary irAEs.By referring to domestic and foreign clinical guidelines,we have proposed practical suggestions for screening,diagnosing and treating pituitary irAEs.

关 键 词：恶性肿瘤 垂体炎 垂体功能减退 免疫检查点抑制剂 免疫相关不良反应 

分 类 号：R979.1[医药卫生—药品]