程序性死亡受体1单抗诱发重度免疫性血小板减少(附3例报告)  

Severe Immune thrombocytopenia induced by programmed death-1 monoclonal antibody:report of 3 cases

作　　者：王振华 虞飞燕 楼芳[2] 陈舒[3] 徐志 WANG Zhenhua;YU Feiyan;LOU Fang;CHEN Shu;XU Zhi(Department of Hematology,Putuo District People's Hospital,Zhoushan City,Zhoushan 316000,Zhejiang Province,China;Department of Oncology,Sir Run Run Shaw Hospital Affiliated to Zhejiang University School of Medicine,Hangzhou 310020,China;Department of Hematology,Zhejiang Provincial Blood Center,Hangzhou 310052,Zhejiang Province,China)

机构地区：[1]浙江省舟山市普陀区人民医院血液科,浙江舟山316000 [2]浙江大学医学院附属邵逸夫医院肿瘤科,杭州310020 [3]浙江省血液中心血液科,杭州310052

出　　处：《中国药师》2024年第8期1459-1464,共6页China Pharmacist

基　　金：浙江省医药卫生科技计划(2018RC029)。

摘　　要：目的分析程序性死亡受体1(PD-1)单抗诱发重度免疫性血小板减少(SIT)的诊断与治疗。方法选取浙江省舟山市普陀区人民医院2020年3月至2022年10月因PD-1单抗治疗导致SIT患者3例,分析其诊疗过程和病情转归。结果3例患者术后病理均确诊恶性肿瘤给予PD-1单抗后诱发SIT,其中1例患者死亡,2例患者经治疗后好转。结论PD-1诱发SIT多发生于12周以后,可结合患者用药史、血小板抗体、骨髓检查明确临床诊断。在治疗上,激素有序减量,血小板生成素、血小板受体激动剂等联合治疗可促进患者恢复。此外,必要时可使用CD20单抗治疗以拮抗血小板抗体。Objective To retrospectively explore the diagnosis and treatment of severe immune thrombocytopenia(SIT)induced by programmed death-1(PD-1)monoclonal antibody.Methods Three patients with SIT caused by PD-1 monoclonal antibody treatment at Putuo District People's Hospital,Zhoushan City,Zhejiang Province from March 2020 to October 2022 were selected,and the diagnosis and treatment process and disease outcome were analyzed.Results All three patients were diagnosed with malignant tumors after postoperative pathological examination,and SIT was induced after PD-1 monoclonal antibody treatment,of which one patient died,and two patients improved after the treatment.Conclusion PD-1 induced SIT often occurs after 12 weeks,and clinical diagnosis can be confirmed by combining patients’medication history,platelet antibodies,and bone marrow examination.In terms of treatment,combination therapy such as ordered reduction of hormones,thrombopoietin,and platelet receptor agonists can promote the recovery of the patient.In addition,if necessary,CD20 monoclonal antibody therapy can be applied to antagonize platelet antibodies.

关 键 词：程序性死亡受体1 重度血小板减少 诊断 治疗 

分 类 号：R558.2[医药卫生—血液循环系统疾病]