免疫检查点抑制剂相关肾上腺损伤病例分析  

Case analysis adrenal damage associated with immune checkpoint inhibitors

作　　者：徐文东 陶静怡 李菁 吴萍[3] 房灏[3] XU Wendong;TAO Jingyi;LI Jing;WU Ping;FANG Hao(Department of Endocrinology and Metabolism,The First People's Hospital of Changzhou,Changzhou 213003,China;School of Pharmacy,Changzhou University,Changzhou 213164,China;Department of Pharmacy,The First People's Hospital of Changzhou,Changzhou 213003,China)

机构地区：[1]常州市第一人民医院内分泌代谢科,江苏常州213003 [2]常州大学药学院,江苏常州213164 [3]常州市第一人民医院药学部,江苏常州213003

出　　处：《常州大学学报（自然科学版）》2024年第6期90-97,共8页Journal of Changzhou University：Natural Science Edition

摘　　要：收集2018年1月至2024年4月常州市第一人民医院收住入院的免疫检查点抑制剂(ICIs)导致的肾上腺皮质功能减退症患者,对其基本情况、肿瘤情况、临床表现、治疗及转归进行描述性统计分析,探讨患者使用ICIs后出现肾上腺皮质功能减退症的临床特征。研究共纳入13例患者,男性11例(84.6%),女性2例(15.4%),中位年龄66岁,从使用ICIs至发生肾上腺皮质功能减退症的中位治疗周期为11个,中位时间为266 d。按美国国立卫生研究院和国家癌症研究所通用不良事件术语标准分级,严重(≥3级)病例占84.6%,13例患者在发生肾上腺皮质功能减退症后均暂停ICIs治疗,1例患者肾上腺皮质功能好转后转用程序性死亡受体-配体1(PD-L1)治疗,肾上腺皮质功能减退症未加重,13例接受糖皮质激素治疗后均病情平稳。综上所述,ICIs所致肾上腺皮质功能减退症多发生于老年患者,临床表现以重症为主,停用ICIs并给予糖皮质激素治疗后大多数患者预后良好,个别患者经权衡利弊后在严密监测下可以更换其他种类ICIs治疗。A descriptive statistical analysis was conducted on patients with adrenal insufficiency caused by immune checkpoint inhibitors(ICIs)admitted to The First People s Hospital of Changzhou from January 2018 to April 2024.The analysis covered the patients basic demographics,tumor characteristics,clinical manifestations,treatment,and outcomes to explore the clinical features of adrenal insufficiency in cancer patients using ICIs.A total of 13 patients were included in the study,comprising 11 males(84.6%)and 2 females(15.4%),with a median age of 66 years old.The median treatment cycle before the onset of drenocortical insufficiency was 11,with a median duration of 266 d from the administration of ICIs.According to the Common Terminology Criteria for Adverse Events by the National Cancer Institute,84.6%of cases were severe(≥Grade 3).13 patients discontinued ICIs after the occurance of adrenal insufficiency,and the antitumor drug of one patient was switched to PD-L1 therapy without adrenal insufficiency recurrence.13 patients were treated with glucocorticoids and remained clinically stable.In summary,adrenal insufficiency predominantly occurs in elderly patients,with severe clinical symptoms being most common.The prognosis is generally good following the discontinuation of ICIs and the administration of glucocorticoid therapy.In selected cases,other drugs of ICIs may be safely selected under close monitoring after weighing the benefits and risks.

关 键 词：免疫检查点抑制剂 肾上腺皮质功能减退症 回顾性研究 免疫相关不良事件 

分 类 号：R586[医药卫生—内分泌]