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恶性肿瘤患者免疫检查点抑制剂导致肝损伤的临床处理2例

Clinical management of liver injury caused by immune checkpoint inhibitors in two patients with malignant tumor

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【作者】 王作林杨华夏陈明张宇张新伟肖建宇潘战宇姜战胜

【Author】 Zuolin Wang;Huaxia Yang;Ming Chen;Yu Zhang;Xinwei Zhang;Jianyu Xiao;Zhanyu Pan;Zhansheng Jiang;Department of Integrative Oncology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer,Tianjin Key Laboratory of Cancer Prevention and Therapy, Tianjin’s Clinical Research Center for Cancer, Tianjin Key Laboratory of Cancer Immunology and Biotherapy;Department of Rheumatology and Immunology, Peking Union Medical College Hospital,Peking Union Medical College, Chinese Academy of Medical Sciences;Department of Digestive, Tianjin Hospital of ITCWM NanKai Hospital;Department of Immunology, Tianjin Medical University Cancer Institute and Hospital;Department of Radiology, Tianjin Medical University Cancer Institute and Hospital;

【通讯作者】 姜战胜;

【机构】 天津医科大学肿瘤医院中西医结合科国家肿瘤临床医学研究中心天津市肿瘤防治重点实验室天津市恶性肿瘤临床医学研究中心天津市肿瘤免疫与生物治疗重点实验室中国医学科学院北京协和医院风湿免疫科天津市中西医结合医院南开医院消化内科天津医科大学肿瘤医院生物治疗肿瘤科天津医科大学肿瘤医院放射科

【摘要】 免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)作为一种新的抗肿瘤药物,目前在临床的使用日益广泛。然而,ICIs过度激活的免疫系统会攻击人体正常器官,引起相关的免疫不良反应,这种免疫损伤可以累及身体的各个部位,引起相应的症状,被称之为ICIs相关不良反应(immunocheckpoint inhibitors related adverse effects,irAEs)。肝损伤作为irAEs其中一种,临床治疗是以糖皮质激素为主,但是对于≥3级以上肝损伤的治疗以及出现激素耐药后的解救治疗仍会让临床医生感到棘手。本研究分析2例经免疫治疗后出现肝损伤的案例,包括激素敏感型1例,激素耐药型1例,后经免疫球蛋白解救治疗成功。

【Abstract】 Immune checkpoint inhibitors(ICIs) constitute a new class of anti-tumor drugs widely used in clinical practice. However, immune toxicity occurs when ICI-induced activation of the immune system leads to damage of the normal organs of the human body. This type of immune damage can affect any part of the body and can cause symptoms known as immunocheckpoint inhibitors related adverse effects(irAEs). Glucocorticoid is the mainstay of treatment for liver injury. However, ways of managing grade ≥3 liver injury and preventing the development of hormone resistance remain unclear. We described two cases of liver injury after immunotherapy: one patient was corticosteroid-sensitive, while the other was corticosteroid-resistant and received salvage treatment with immunoglobulin.

【基金】 自然科学基金项目(编号:81803914);天津市自然科学基金项目(编号:18jczdjc36700)资助~~
  • 【文献出处】 中国肿瘤临床 ,Chinese Journal of Clinical Oncology , 编辑部邮箱 ,2020年23期
  • 【分类号】R730.51;R575
  • 【下载频次】186
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