替雷利珠单抗致免疫相关性多系统不良反应1例  

A case report of immune-related multisystem adverse reactions caused by tislelizumab

作　　者：宋秋艳[1] 台琪瑞[1] 张毕奎[2] 罗芝英 孙宝 刘文辉[2] SONG Qiuyan;TAI Qirui;ZHANG Bikui;LUO Zhiying;SUN Bao;LIU Wenhui(Department of Pharmacy,People’s Hospital of Yuxi City,Yuxi 653100,Yunnan Province,China;Department of Pharmacy,The Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]玉溪市人民医院药学部,云南玉溪653100 [2]中南大学湘雅二医院药剂科,长沙410001

出　　处：《药物流行病学杂志》2025年第3期359-364,共6页Chinese Journal of Pharmacoepidemiology

摘　　要：1例35岁晚期肺癌女性患者,接受紫杉醇(白蛋白结合型)+卡铂注射剂化疗联合替雷利珠单抗注射液免疫治疗一周期。治疗后第6天,患者出现右侧眼睑较左侧下垂、晨轻暮重,以及全身肌肉酸痛,转氨酶、心肌酶异常,心电图异常,考虑为替雷利珠单抗相关性重症肌无力及相关性肌炎可能。入院后,予甲泼尼龙、静脉注射用人免疫球蛋白、血浆置换、吗替麦考酚酯、安装临时起搏器、气管插管等治疗1月余,患者指标较前下降,神志昏迷,患者家属要求出院。采用Naranjo's评估量表对该病例的多系统不良反应与替雷利珠单抗的关联性进行评价,评分为7分,结果为“很可能有关”。本病例提示临床使用替雷利珠单抗过程中应加强风险因素评估及用药监护,以确保患者用药安全。A 35-year-old female patient with advanced lung cancer was treated with paclitaxel(albumin-bound)and carboplatin chemotherapy,combined with tislelizumab immunotherapy for one cycle.After 6 days of treatment,the patient developed sagging of the right eyelid compared to the left side,mild morning and heavy evening,systemic muscle soreness,abnormal transaminases and myocardial enzymes,and abnormal electrocardiogram.It is suspected that there may be a correlation between tislelizumab and myasthenia gravis or related myositis.After admission,patients were treated with methylprednisolone,intravenous immunoglobulin,plasma exchange,mycophenolate mofetil,temporary pacemaker installation,and tracheal intubation.After more than a month of treatment,the patient's indicators decreased,but the patient became unconscious,the patient’s family requested discharge.The association between the multisystem adverse reactions and tislelizumab was evaluated using the Naranjo's Assessment Scale,the correlation score was 7 and evaluated as probably relevant.It is suggested that when using tislelizumab in clinical practice,risk factor assessment and medication monitoring should be strengthened to ensure drug safety.

关 键 词：替雷利珠单抗 重症肌无力 肌炎 心肌炎 肝损伤 免疫相关不良反应 

分 类 号：R979.1[医药卫生—药品]