原发性肝癌患者并发免疫检查点抑制剂相关肝损伤的临床特征及预后分析  

Clinical Features and Prognostic Analysis of Liver Injury Associated with Immune Checkpoint Inhibitors in Patients with Primary Liver Cancer

作　　者：曹静 刘慈 CAO Jing;LIU Ci(Beijing Shuili Hospital,Beijing 100036,China;不详)

机构地区：[1]北京水利医院,北京100086

出　　处：《中外医学研究》2025年第10期127-132,共6页CHINESE AND FOREIGN MEDICAL RESEARCH

摘　　要：目的:探讨原发性肝癌患者并发免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)相关肝损伤的临床特征及预后分析。方法:收集2020年6月—2021年6月在北京水利医院接受治疗并有ICIs治疗史的100例原发性肝癌患者的临床资料,统计ICIs相关肝损伤发生率、临床特征,采用多因素logistic回归分析影响患者并发ICIs相关肝损伤的危险因素,并连续随访3年,记录患者总生存期(overall survival,OS)。结果:纳入的100例原发性肝癌患者中,共发生ICIs相关肝损伤36例,发生率为36.00%。ICIs相关肝损伤患者以全身皮肤及巩膜黄染为主要临床症状,构成比为55.56%;严重程度分级中2级、3级、4级分别占比8.33%、77.78%、13.89%;肝损伤类型中胆汁淤积型、混合型、肝细胞损伤型分别占比33.33%、16.67%、50.00%;用药时间中<3个月、3~6个月、>6个月占比分别为66.67%、27.78%、5.56%。单因素分析显示,ICIs相关肝损伤组年龄≥60岁、合并非酒精性脂肪肝病(nonalcoholic fatty liver disease,NAFLD)、ICIs类型为CTLA-4占比高于非肝损伤组,差异有统计学意义(P<0.05);两组性别、BMI、病理类型、TNM分期、分化程度、癌灶最大径、ICIs药物、治疗方案比较,差异无统计学意义(P>0.05)。多因素logistic回归分析显示,年龄≥60岁、合并NAFLD与CTLA-4是影响原发性肝癌患者并发ICIs相关肝损伤的危险因素(P<0.05)。连续随访3年,原发性肝癌并发ICIs相关肝损伤患者OS为22.5个月,短于无ICIs相关肝损伤患者26.0个月,差异有统计学意义(P<0.05)。结论:原发性肝癌患者ICIs治疗引起的相关肝损伤发生率较高,其中年龄、合并NAFLD、ICIs类型是其主要影响因素,且ICIs相关肝损伤与患者预后存在一定关系。Objective:To investigate the clinical features and prognosis analysis of liver injury associated with immune checkpoint inhibitors(ICIs)in patients with primary liver cancer.Method:Clinical data of 100 patients with primary liver cancer who received treatment in Beijing Shuili Hospital and had a history of ICIs treatment from June 2020 to June 2021 were collected.The incidence rate and clinical characteristics of ICIS-related liver injury were analyzed.The risk factors of patients with ICIS-related liver injury were analyzed by multivariate logistic regression analysis,the patients were followed up for 3 years and overall survival(OS)was recorded.Result:Among 100 patients with primary liver cancer,36 cases of ICIS-related liver injury occurred,the incidence rate was 36.00%.The main clinical symptoms of ICIS-related liver injury were systemic skin and scleral yellow stain,and the proportion was 55.56%.The severity of grade 2,grade 3 and grade 4 accounted for 8.33%,77.78%and 13.89%respectively.Cholestasis,mixed type and hepatocyte injury accounted for 33.33%,16.67%and 50.00%,respectively.The proportion of<3 months,3~6 months and>6 months were 66.67%,27.78%and 5.56%,respectively.Univariate analysis showed that the proportion of ICIS-related liver injury group aged≥60 years,combined nonalcoholic fatty liver disease(NAFLD),ICIs type CTLA-4 was higher than that of non-liver injury group,and the differences were statistically significant(P<0.05).There were no significant differencse in gender,BMI,pathological type,TNM stage,differentiation degree,maximum diameter of cancer focus,ICIs drug and treatment plan between the two groups(P>0.05).Multi-factor logistic regression analysis showed that age≥60 years old,combined with NAFLD and CTLA-4 were risk factors for ICIS-related liver injury in patients with primary liver cancer(P<0.05).After 3 years of follow-up,the OS of primary liver cancer patients complicated with ICIS-related liver injury was 22.5 months,which was shorter than that of patients without ICIS-related li

关 键 词：原发性肝癌 免疫检查点抑制剂 肝损伤 临床特征 预后 

分 类 号：R735.7[医药卫生—肿瘤]