免疫检查点抑制剂治疗相关静脉血栓栓塞症的研究进展  

Research progress of immune checkpoint inhibitor therapy-immune-related venous thromboembolic events

作　　者：李慧敏[1] 李宏 罗琴[1] LI Huimin;LI Hong;LUO Qin(Department of Respiratory and Neurology,the Affiliated Tumor Hospital of Xinjiang Medical University,Xinjiang Urumqi 830011,China)

机构地区：[1]新疆医科大学附属肿瘤医院呼吸神经内科,新疆乌鲁木齐830011

出　　处：《现代肿瘤医学》2023年第13期2546-2552,共7页Journal of Modern Oncology

基　　金：国家自然科学基金(编号:81760014);自治区科技支疆项目(编号:2019E0281);新疆维吾尔自治区自然科学基金资助项目(编号:2022D01D74)。

摘　　要：近年来,静脉血栓栓塞症(venous thromboembolism,VTE)已成为仅次于恶性肿瘤本身的第二位死亡原因。在精准治疗时代,既往标准癌症治疗手段已证实与VTE形成密切相关,如手术、化疗以及抗血管生成靶向治疗等。当代基于程序性死亡受体及其配体(programmed cell death 1 or its ligand,PD-1/PD-L1)或细胞毒性T淋巴细胞抗原4(cytotoxic T-lymphocyte antigen 4,CTLA4)为治疗靶点的免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)的应用日趋成为常态并已成为指南推荐。然而,由ICIs诱导的各种非靶向自身免疫表现即免疫相关不良事件(immune-related adverse events,irAEs)不容忽视,其诱导的全身炎症对止血系统的影响迄今尚未得到适当研究。因此,临床医生非常有必要加强对ICIs相关VTE不良事件的认识。本文就ICIs相关VTE的发生率、危险因素、发病机制及临床管理原则等方面进行综述,以期为临床实践中免疫治疗相关静脉血栓的一级预防及精准治疗提供参考。VTE,which includes pulmonary thromboembolism(PE)and deep vein thrombosis(DVT),is the second leading cause of death in cancer patients.Many factors can contribute to the increased risk of thrombosis in patients with cancer,especially treatment-related factors,such as surgery,chemotherapy,and more recently anti-angiogenesis agents.Currently,immune checkpoint inhibitors(ICIs)impair tumor immune-escape mechanisms by targeting programmed cell death 1 or its ligand(PD-1/PD-L1)or cytotoxic T-lymphocyte antigen 4(CTLA-4).The most common ICIs adverse effects are immune-related adverse events(irAEs)that may potentially affect any organs or systems,including skin,thyroid,gastrointestinal,or hematological disorders such as autoimmune hemolytic anemia or thrombocytopenia.However,thrombosis had not been commonly reported as irAEs in landmark phase III clinical trials of ICIs.Therefore,there is a great need for clinicians to improve their understanding of ICIs-associated VTE events.This article reviews the VTE incidence,risk factors,its potential pathogenesis and management principles of VTE caused by ICIs treatment,thus guiding the implementation of clinical VTE prevention and treatment for patients on ICIs.

关 键 词：肿瘤相关静脉血栓栓塞症 免疫检查点抑制剂 免疫相关不良事件 抗凝治疗 

分 类 号：R730.5[医药卫生—肿瘤]