信迪利单抗致免疫性肠炎引发肠道大出血1例  

A case of intestinal hemorrhage caused by immune enteritis due to sintilimab

作　　者：孟保伟 吴才志 马永明 常瑞同 杨小刚 田华山 武志强 尹蕊[1] 朱自江 MENG Baowei;WU Caizhi;MA Yongming;CHANG Ruitong;YANG Xiaogang;TIAN Huashan;WU Zhiqiang;YIN Rui;ZHU Zijiang(Department of Thoracic Surgery,Gansu Maternal and Child Health Hospital/Gansu Provincial Central Hospital,Lanzhou 730000,China;First Clinical Medical School of Lanzhou University,Lanzhou 730000,China;First Clinical Medical School of Gansu University of Chinese Medicine,Lanzhou 730000,China)

机构地区：[1]甘肃省妇幼保健院/甘肃省中心医院胸外科,兰州730000 [2]兰州大学第一临床医学院,兰州730000 [3]甘肃中医药大学第一临床医学院,兰州730000

出　　处：《药物流行病学杂志》2024年第7期818-823,共6页Chinese Journal of Pharmacoepidemiology

摘　　要：1例68岁非小细胞肺鳞癌患者接受6周期信迪利单抗联合化疗后,予信迪利单抗200 mg,ivd单药治疗出现严重腹泻、腹痛、便血等不适,彩超及肠镜表明肠道广泛充血炎症,病理活检综合考虑为急性免疫性肠炎。暂停免疫治疗,给予足量糖皮质激素及对症治疗,2 d后患者腹泻、便血好转,6 d后症状缓解恢复正常。经评估,该患者免疫性肠炎不良反应与信迪利单抗的关联性为很可能有关。本文通过对信迪利单抗致免疫相关性肠炎的病例进行文献复习,阐述如何在临床中运用实验室检查、肠镜等检测其病理改变并结合临床腹泻、便血等表现进行诊断鉴别,参考指南分级进行及时处理,并根据本病例加以讨论,以期提高临床医师相关场景下的识别和处理能力。A 68-year-old patient with non-small cell lung squamous carcinoma who received 6 cycles of sintilimab combination chemotherapy and sintilimab 200 mg,ivd,monotherapy developed severe diarrhea,abdominal pain,blood in the stool and other discomforts,and ultrasound and colonoscopy demonstrated extensive congestion and inflammation in the intestinal tract,and the pathologic biopsy was comprehensively considered to be an acute immune enteritis.Immunotherapy was suspended,adequate glucocorticoids and symptomatic treatment were given,and the patient's diarrhea and blood in stool improved after 2 days,and the symptoms were relieved and returned to normal after 6 days.The association between the patient's immune enteritis and sintilimab was assessed as probably relerant.This article reviews the literature on the case of immune-associated enteritis caused by sintilimab,describes how to use experimental methods and enteroscopy to detect the pathological changes in the clinic,and combines them with the clinical manifestations of diarrhea and blood in the stools to make the diagnosis and differentiation,and then refers to the guideline grading for timely management,and discusses the case to improve the clinicians'ability to recognize and deal with the relevant scenarios.

关 键 词：信迪利单抗 非小细胞肺癌 免疫性肠炎 肠道出血 药品不良反应 

分 类 号：R979.1[医药卫生—药品]