肿瘤免疫治疗相关的视神经不良反应及其防治的研究进展  

Research progress of tumor immunotherapy-associated optic nerve adverse events,prevention and treatment

作　　者：张露尹 姜利斌[1] Zhang Luyin;Jiang Libin(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing 100730,China)

机构地区：[1]首都医科大学附属北京同仁医院、北京同仁眼科中心,北京100730

出　　处：《中华眼底病杂志》2023年第10期857-861,共5页Chinese Journal of Ocular Fundus Diseases

基　　金：首都卫生发展科研专项项目(首发2020-2-1082);北京市自然科学基金(7222028)。

摘　　要：肿瘤免疫治疗主要包括免疫检查点抑制剂(ICI)、肿瘤疫苗、过继性细胞疗法及新型免疫治疗等。肿瘤免疫治疗作为晚期恶性肿瘤全身治疗的主要手段,通过激活机体免疫系统,杀伤肿瘤细胞,从而延长患者生存期,但过度的免疫反应会产生免疫相关不良反应(irAE),造成全身组织的损害。ICI是主要引起视神经irAE的肿瘤免疫治疗药物。视神经炎是最常见的视神经irAE,少数患者表现为动脉炎性前部缺血性视神经病变。视神经irAE最常见的临床表现是双眼突发性无痛性视力下降,严重者视力降至无光感。早诊断及早期足量糖皮质激素治疗可显著改善患者症状。因此,神经眼科和肿瘤科医生应当了解视神经irAE的临床特点,以便早期对该病进行诊断和治疗,更好地改善疾病的预后。Tumor immunotherapy includes immune checkpoint inhibitor(ICI),tumor vaccines,and adoptive cell therapy.Immunotherapy,as the main systemic treatment for advanced malignant tumors,kills tumor cells by activating the immune system and prolongs the survival of patients.However,excessive immune responses can cause immune-related adverse events(irAE),causing damage to systemic tissues.ICI are the main tumor immunotherapy drugs that cause optic nerve irAE.The most common optic nerve irAE are optic neuritis,only a few patients appeared arteritic anterior ischemic optic neuropathy.Sudden painless loss of bilateral vision is the most common clinical manifestation.In severe cases,the vision decrease to no light perception.Early diagnosis and early adequate glucocorticoid treatment can improve the symptoms.Therefore,neuroophthalmologists and oncologists should know the clinical characteristics of optic nerve irAE,in order to diagnose and treat early and improve the prognosis.

关 键 词：免疫治疗 免疫检查点抑制剂 免疫相关不良反应 视神经病变 综述 

分 类 号：R730.51[医药卫生—肿瘤] R774.6[医药卫生—临床医学]