老年肿瘤患者程序性细胞死亡受体1抑制剂诱发甲状腺功能减退症的相关因素  

Related factors of hypothyroidism induced by programmed death(PD)-1 treatment in elderly patients with cancer

作　　者：杜攀 杨颖 王方 朱建强 周雪 陈成 康琳 Du pan;Yang Ying;Wang Fang;Zhu Jianqiang;Zhou Xue;Chen Cheng;Kang Lin(Department of Geriatrics,Xiangyang Central Hospital,Affiliated to Hubei University of Arts and Sciences,Xiangyang 441106,China;Department of Oncology,Xiangyang Central Hospital,Affiliated to Hubei University of Arts and Sciences,Xiangyang 441106,China;Department of Geriatrics,Peking Union Medical College Hospital,Beijing 100730,China)

机构地区：[1]湖北文理学院附属医院,襄阳市中心医院老年医学科,襄阳441106 [2]湖北文理学院附属医院,襄阳市中心医院肿瘤科,襄阳441106 [3]中国医学科学院,北京协和医院老年医学科,北京100730

出　　处：《中华老年医学杂志》2024年第5期592-596,共5页Chinese Journal of Geriatrics

基　　金：中央高水平医院临床科研业务费资助(2022-PUMCH-B-129)。

摘　　要：目的探究老年肿瘤患者程序性细胞死亡受体1(PD-1)抑制剂治疗后诱发甲状腺功能减退症(甲减)的相关因素。方法回顾性分析了2018年1月至2021年1月襄阳市中心医院肿瘤科接受PD-1抑制剂治疗的老年晚期实体肿瘤患者(≥60岁)193例,根据PD-1抑制剂治疗后是否诊断甲减分为甲减组(36例)和非甲减组(157例),比较两组患者的临床资料[包括年龄、性别、美国东部肿瘤协作组(ECOG)体力状况(PS)评分、PD-1抑制剂药物、甲状腺功能、甲状腺抗体],并分析甲减发生的相关因素。结果193例患者有36例(18.7%)出现甲减,甲减组和非甲减组在年龄、性别、ECOG PS评分、肿瘤类型、PD-1抑制剂药物方面比较,差异均无统计学意义(均P>0.05)。而在基线促甲状腺激素(TSH)及基线甲状腺抗体分组中比较,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,基线抗甲状腺过氧化物酶抗体(TPOAb)(+)(OR=20.256、95%CI:5.709~71.868、P<0.001)、基线TPOAb(+)和甲状腺球蛋白抗体(TGAb)(+)(OR=5.853、95%CI:1.475~23.227、P=0.012)及基线TSH升高(OR=3.065、95%CI:1.049~8.959、P=0.041)是PD-1抑制剂诱发老年肿瘤患者甲减的相关因素,而基线TGAb(+)与甲减的发生关系不显著(OR=1.373、95%CI:0.353~5.341、P=0.648)。结论PD-1抑制剂治疗老年肿瘤患者甲减发病率高,尤其PD-1抑制剂治疗前基线TSH升高及基线TPOAb阳性的患者发生甲减的风险更高;因此,在PD-1抑制剂治疗期间需警惕甲减的发生,及时发现甲减进行替代治疗,以减少不良事件的发生。Objective To investigate the factors related to hypothyroidism induced by programmed death(PD)-1 treatment in elderly patients with cancer.Methods A total of 193 older patients(≥60 years old)with advanced solid tumors who received PD-1 treatment between January 2018 and January 2021 at the Department of Oncology of Xiangyang Central Hospital were included in this study.The patients were divided into two groups based on whether they were diagnosed with hypothyroidism after PD-1 treatment:the hypothyroidism group(36 cases)and the non-hypothyroidism group(157 cases).The clinical data of both groups,including age,gender,Eastern Cooperative Oncology Group performance status(ECOG PS),PD-1 inhibitors,thyroid function,and thyroid antibody,were compared to analyze the risk factors associated with hypothyroidism.Results Among the 193 patients,36(18.7%)were diagnosed with hypothyroidism.The study found no significant differences between the two groups in terms of age,gender,ECOG PS,tumor type,and PD-1 type(all P>0.05).However,significant differences were observed in the baseline levels of thyroid stimulating hormone(TSH)and thyroid antibody subgroups(both P<0.05).The results of multivariate Logistic regression analysis revealed that the presence of baseline anti-thyroid peroxidase antibody(TPOAb)(OR=20.256,95%CI:5.709-71.868,P<0.001),the presence of both baseline thyroglobulin antibody(TGAb)and TPOAb(OR=5.853,95%CI:1.475-23.227,P=0.012),and an increase in baseline TSH levels(OR=3.065,95%CI:1.049-8.959,P=0.041)were identified as risk factors for hypothyroidism induced by PD-1 treatment.On the other hand,there was no significant association between the presence of baseline TGAb and the occurrence of hypothyroidism(OR=1.373,95%CI:0.353-5.341,P=0.648).Conclusions The incidence rate of hypothyroidism induced by PD-1 inhibitors is high among elderly patients with cancer.Additionally,the risk of hypothyroidism is higher in patients with elevated baseline TSH and positive TPOAb.Therefore,it is crucial to remain vigilant for the o

关 键 词：免疫球蛋白类 甲状腺刺激 甲状腺功能减退症 PD-1抑制剂 

分 类 号：R730.6[医药卫生—肿瘤]