中药联合PD-1/PD-L1抑制剂治疗恶性肿瘤不良反应的回顾性分析  

Retrospective analysis of adverse reactions in the treatment of malignant tumors with traditional Chinese medicine combined with PD-1/PD-L1 inhibitors

作　　者：柴小姝[1] 张松 吴万垠[1] 李柳宁[1] 张力文[1] 陈志坚[1] 洪宏喜[1] 何春霞[1] 刘柏[1] CHAI Xiaoshu;ZHANG Song;WU Wanyin;LI Liuning;ZHANG Liwen;CHEN Zhijian;HONG Hongxi;HE Chunxia;LIU Bai(Department of Oncology,Higher Education Mega Center Hospital of Guangdong Provincial Hospital of Traditional Chinese Medicine,Guangzhou 510006,China;The Third Affiliated Hospital of Guangzhou University of Chinese Medicine,Guangzhou 510000,China)

机构地区：[1]广东省中医院大学城医院内三科,广东广州510006 [2]广州中医药大学第三附属医院,广东广州510000

出　　处：《广东药科大学学报》2023年第4期106-111,共6页Journal of Guangdong Pharmaceutical University

基　　金：广州市科学技术局项目(202206010039)。

摘　　要：目的探讨中药联合程序性细胞死亡蛋白-1(PD-1)或程序性死亡蛋白配体-1(PD-L1)抑制剂在临床应用中的免疫相关不良反应发生情况并总结其特征。方法回顾性分析2019年9月至2022年1月在本院接受中药联合PD-1/PD-L1抑制剂治疗各类晚期实体恶性肿瘤的患者,记录患者接受治疗期间发生的所有不良反应信息,并进行严重程度分级和影响因素分析。结果共录入160例患者,其中57例患者发生不良反应,发生率为35.63%,主要有内分泌毒性(22.50%)、皮肤毒性(6.25%)、心脏毒性(6.25%)、胃肠毒性(5.00%)、肺毒性(3.75%)、肝脏毒性(1.88%)、反应性皮肤毛细血管增生症(1.25%)、血液毒性(0.63%)、肾脏毒性(0.63%)等。其中1、2级不良反应58次,3、4级不良反应16次。结论中药联合PD-1/PD-L1抑制剂引起的不良反应发生率较文献报道中单纯PD-1/PD-L1抑制剂低,严重程度较轻,提示中药辩证治疗可减轻免疫检查点抑制剂所致不良反应。Objective To investigate the occurrence and characteristics of immune-related adverse reactions in the clinical application of traditional Chinese medicine combined with programmed cell death protein-1(PD-1)or programmed death protein ligand-1(PD-L1)inhibitors.Methods A retrospective analysis was performed for patients with various advanced solid malignancies treated with traditional Chinese medicine combined with PD-1/PD-L1 inhibitors in our hospital from September 2019 to January 2022,and all adverse reactions occurred during treatment were recorded,and the severity grading and influencing factors were analyzed.Results A total of 160 patients were enrolled,of which 57 patients had adverse reactions with an incidence of 35.63%,mainly including endocrine toxicity(22.50%),skin toxicity(6.25%),cardiotoxicity(6.25%),gastrointestinal toxicity(5.00%),pulmonary toxicity(3.75%),liver toxicity(1.88%),reactive cutaneous capillary hyperplasia(1.25%),hematological toxicity(0.63%),nephrotoxicity(0.63%),etc.Among them,there were 58 grade 1 and 2 adverse reactions,and 16 grade 3 and 4 adverse reactions.Conclusion The incidence of adverse reactions caused by traditional Chinese medicine combined with PD-1/PD-L1 inhibitors is lower and less severe than that of PD-1/PD-L1 inhibitors alone,suggesting that dialectical treatment of traditional Chinese medicines can reduce the adverse reactions caused by immune checkpoint inhibitors.

关 键 词：中药 PD-1/PD-L1 免疫相关不良事件 免疫治疗 

分 类 号：R978.69[医药卫生—药品]