42例免疫检查点抑制剂相关肺炎的CT影像分型研究  

CT imaging classification characteristics of 42 cases of immune checkpoint inhibitor-related pneumonitis

作　　者：赵颖 王锋 宋勇 陈歆妮 梅魁敏 李慧 秦叔逵 褚晓源 高红 ZHAO Ying;WANG Feng;SONG Yong;CHEN Xinni;MEI Kuimin;LI Hui;QIN Shukui;CHU Xiaoyuan;GAO Hong(Department of Imaging,Jinling Hospital,Affiliated Hospital of Medical School,Nanjing University,Nanjing 210002,China)

机构地区：[1]南京大学医学院附属金陵医院放射科,南京210002 [2]南京大学医学院附属金陵医院肿瘤科,210002 [3]南京大学医学院附属金陵医院呼吸与危重症医学科,210002

出　　处：《临床肿瘤学杂志》2023年第12期1040-1045,共6页Chinese Clinical Oncology

摘　　要：目的探讨免疫检查点抑制剂相关肺炎(CIP)的CT影像特征。方法回顾性分析CIP患者的胸部CT检查图像、临床诊疗经过和随访结果,进行影像学分型,总结各分型特征,分析与其他肺部病变的鉴别要点。结果2016年9月1日至2022年12月31日,1354例恶性肿瘤患者在本院肿瘤科接受免疫检查点抑制剂单药或联合治疗,共发生CIP 42例,发生率为3.1%(42/1354),共9例患者死亡,死亡率为0.7%(9/1354)。根据CT影像将CIP分为5种类型:磨玻璃型(10例)、斑片型(16例)、肺实变型(2例)、网格型(3例)和混合型(11例),各分型具有特征性的影像表现并有不同的临床转归,需要与感染性肺炎、肿瘤进展、放射性肺炎等相鉴别。结论CT影像特征有助于CIP的早期诊断,预测激素敏感性和判断预后。Objective To investigate the CT imaging features of checkpoint inhibitor-related pneumonitis(CIP).Methods The chest CT images of patients with CIP were analyzed.The imaging characteristics and main points of differentiation from other pulmonary diseases were summarized.Results From September 1,2016 to December 31,2022,1354 malignant tumor patients received monotherapy or combination therapy of immune checkpoint inhibitors in the oncology department of our hospital.A total of 42 cases of CIP occurred,with an incidence rate of 3.1%(42/1354).A total of 9 patients died,with a mortality rate of 0.7%(9/1354).CIP could be divided into 5 types based on CT imaging,namely ground glass type(10 cases),patchy type(16 cases),pulmonary consolidation type(2 cases),grid type(3 cases),and mixed type(11 cases).Each type had characteristic imaging manifestations and different clinical outcomes,and needed to be distinguished from infectious pneumonia,tumor progression,radiation pneumonia,etc.Conclusion CT imaging features are helpful for the early diagnosis of CIP,predicting hormone sensitivity and prognosis.

关 键 词：恶性肿瘤 免疫检查点抑制剂 肺炎 影像分型 

分 类 号：R73[医药卫生—肿瘤]