信迪利单抗致甲状腺功能减退继发大量心包积液的病例分析  

Massive pericardial effusion secondary to hypothyroidism induced by sintilimab

作　　者：吴玉佩 尹岳松 方灵芝[1] 张丽娜[3] Wu Yupei;Yin Yuesong;Fang Lingzhi;Zhang Lina(Department of Pharmacy,Hebei General Hospital,Shijiazhuang 050051,China;Department of Oncology,Hebei General Hospital,Shijiazhuang 050051,China;Department of Cardiology,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院药学部,河北石家庄050051 [2]河北省人民医院肿瘤科,河北石家庄050051 [3]河北省人民医院心血管内科,河北石家庄050051

出　　处：《实用药物与临床》2023年第9期839-842,共4页Practical Pharmacy and Clinical Remedies

基　　金：河北省重点研发计划项目(20377769D)。

摘　　要：1例诊断为胃癌伴淋巴结转移的72岁男性患者,给予信迪利单抗联合替吉奥治疗。第2周期治疗前出现甲状腺功能减退,考虑为信迪利单抗所致,给予左甲状腺素钠片治疗后,患者乏力症状缓解,继续应用信迪利单抗免疫治疗,共完成6个周期。信迪利单抗末次治疗2个月后,患者自行停用左甲状腺素片,停药7个月后,心脏彩超检查发现大量心包积液,TT3<0.3 nmol/ml,TT4<5.4 nmol/ml,FT30.567 pmol/ml,FT41.37 pmol/ml,TSH>100μIU/ml,考虑为甲状腺功能减退性心包积液,给予左甲状腺素钠片治疗后,患者TT3、TT4、FT3、FT4和TSH逐渐恢复正常,心包积液显著减少。A 72-year-old man diagnosed with gastric cancer with lymph node metastasis was treated with sintilimab and tegafur.Hypothyroidism occurred before the second cycle of treatment,which was considered to be caused by sintilimab.After treatment with levothyroxine sodium tablets,fatigue symptom of the patient was relieved,and sintilimab immunotherapy continued.A total of 6 cycles were completed.Two months after the last dose of sintilimab,the patient stopped levothyroxine on his own.Seven months later,the heart doppler ultrasound showed massive pericardial effusion,and the examination of thyroid function indicated TT3<0.3 nmol/mL,TT4<5.4 nmol/ml,FT30.567 pmol/ml,FT41.37 pmol/ml and TSH>100μIU/ml.Hypothyroidism pericardial effusion was considered,and levothyroxine sodium tablets were immediately given to the patient.During follow-up,TT3,TT4,FT3,FT4 and TSH gradually returned to normal,and pericardial effusion decreased significantly.

关 键 词：信迪利单抗 甲状腺功能减退 心包积液 药物不良反应 

分 类 号：R969[医药卫生—药理学]