帕博利珠單抗致免疫相關性肺炎一例及診治分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

陳子謂 ^1,2 ,  廖槐 ¹ , 匡煜坤 ¹ , 唐可京 ¹

1. ;
2. ;

Corresponding?author：

廖槐, Email: liaohuai@mail.sysu.edu.cn

Keywords：

免疫檢查點抑制劑; 免疫檢查點抑制劑肺炎; 支氣管鏡冷凍肺活檢

DOI：

10.7507/1671-6205.202107026

Video：

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目的提高免疫檢查點抑制劑相關性肺炎（CIP）的早期診斷與治療。方法對 1 例接受程序性死亡蛋白-1 單抗治療的晚期肺腺癌患者繼發免疫相關性肺炎的臨床表現、影像學、微生物學、支氣管鏡檢查、病理診斷及治療過程進行回顧分析。結果該例患者經過支氣管鏡冷凍肺活檢病理顯示為機化性肺炎，早期診斷 CIP，臨床分級 2 級，予停用免疫檢查點抑制劑，同時給予口服強的松（按 1 mg· kg^–1· d^–1）治療 2 周后癥狀好轉，復查胸部 CT 見肺部病灶較前大部分吸收。結論 CIP 臨床表現多樣化，早期診斷困難；支氣管鏡檢查尤其是經支氣管鏡冷凍肺活檢有助早期 CIP 明確診斷，CIP 使用糖皮質激素治療效果好。

Citation： 陳子謂, 廖槐, 匡煜坤, 唐可京. 帕博利珠單抗致免疫相關性肺炎一例及診治分析. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(9): 661-664. doi: 10.7507/1671-6205.202107026 Copy

1.	王漢萍, 郭瀟瀟, 周佳鑫, 等. 免疫檢查點抑制劑相關肺炎的臨床診治建議. 中國肺癌雜志, 2019, 22(10): 621-626.
2.	Nishino M, Sholl LM, Hodi FS, et al. Anti-PD-1-related pneumonitis during cancer immunotherapy. N Engl J Med, 2015, 373(3): 288-290.
3.	Nishino M, Giobbie-Hurder A, Hatabu H, et al. Incidence of programmed cell death 1 inhibitor-related pneumonitis in patients with advanced cancer: a systematic review and meta-analysis. JAMA Oncol, 2016, 2(12): 1607-1616.
4.	陳玉玲, 趙靜, 賈茹, 等. 程序性死亡蛋白-1 抑制劑 Pembrolizumab 致免疫相關肺炎一例并文獻復習. 中華結核和呼吸雜志, 2017, 40(10): 736-743.
5.	中華醫學會呼吸病學分會肺癌學組. 免疫檢查點抑制劑相關肺炎診治專家共識. 中華結核和呼吸雜志, 2019, 42(11): 820-825.
6.	Rashdan S, Minna JD, Gerber DE. Diagnosis and management of pulmonary toxicity associated with cancer immunotherapy. Lancet Respir Med, 2018, 6(6): 472-478.
7.	Suresh K, Voong KR, Shankar B, et al. Pneumonitis in non-small cell lung cancer patients receiving immune checkpoint immunotherapy: incidence and risk factors. J Thorac Oncol, 2018, 13(12): 1930-1939.
8.	Delaunay M, Cadranel J, Lusque A, et al. Immune-checkpoint inhibitors associated with interstitial lung disease in cancer patients. Eur Respir J, 2017, 50(2): 1700050.
9.	李珊, 黃慧, 徐作軍. 經支氣管鏡冷凍肺活檢在彌漫性間質性肺病診斷中的應用. 國際呼吸雜志, 2017, 37(18): 1429-1431.
10.	Babiak A, Hetzel J, Krishna G, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration, 2009, 78(2): 203-208.
11.	李一詩, 郭述良, 曹友德. 經支氣管冷凍肺活檢二例. 中華結核和呼吸雜志, 2016, 39(11): 905-907.
12.	中華醫學會呼吸病學分會介入呼吸病學學組, 中國醫師協會呼吸醫師分會介入呼吸病學工作委員會. 經支氣管冷凍活檢技術臨床應用專家共識. 中華結核和呼吸雜志, 2019, 42(6): 405-412.
13.	Naidoo J, Wang X, Woo KM, et al. Pneumonitis in patients treated with anti-programmed death-1/programmed death ligand 1 therapy. J Clin Oncol, 2017, 35(7): 709-717.

1. 王漢萍, 郭瀟瀟, 周佳鑫, 等. 免疫檢查點抑制劑相關肺炎的臨床診治建議. 中國肺癌雜志, 2019, 22(10): 621-626.
2. Nishino M, Sholl LM, Hodi FS, et al. Anti-PD-1-related pneumonitis during cancer immunotherapy. N Engl J Med, 2015, 373(3): 288-290.
3. Nishino M, Giobbie-Hurder A, Hatabu H, et al. Incidence of programmed cell death 1 inhibitor-related pneumonitis in patients with advanced cancer: a systematic review and meta-analysis. JAMA Oncol, 2016, 2(12): 1607-1616.
4. 陳玉玲, 趙靜, 賈茹, 等. 程序性死亡蛋白-1 抑制劑 Pembrolizumab 致免疫相關肺炎一例并文獻復習. 中華結核和呼吸雜志, 2017, 40(10): 736-743.
5. 中華醫學會呼吸病學分會肺癌學組. 免疫檢查點抑制劑相關肺炎診治專家共識. 中華結核和呼吸雜志, 2019, 42(11): 820-825.
6. Rashdan S, Minna JD, Gerber DE. Diagnosis and management of pulmonary toxicity associated with cancer immunotherapy. Lancet Respir Med, 2018, 6(6): 472-478.
7. Suresh K, Voong KR, Shankar B, et al. Pneumonitis in non-small cell lung cancer patients receiving immune checkpoint immunotherapy: incidence and risk factors. J Thorac Oncol, 2018, 13(12): 1930-1939.
8. Delaunay M, Cadranel J, Lusque A, et al. Immune-checkpoint inhibitors associated with interstitial lung disease in cancer patients. Eur Respir J, 2017, 50(2): 1700050.
9. 李珊, 黃慧, 徐作軍. 經支氣管鏡冷凍肺活檢在彌漫性間質性肺病診斷中的應用. 國際呼吸雜志, 2017, 37(18): 1429-1431.
10. Babiak A, Hetzel J, Krishna G, et al. Transbronchial cryobiopsy: a new tool for lung biopsies. Respiration, 2009, 78(2): 203-208.
11. 李一詩, 郭述良, 曹友德. 經支氣管冷凍肺活檢二例. 中華結核和呼吸雜志, 2016, 39(11): 905-907.
12. 中華醫學會呼吸病學分會介入呼吸病學學組, 中國醫師協會呼吸醫師分會介入呼吸病學工作委員會. 經支氣管冷凍活檢技術臨床應用專家共識. 中華結核和呼吸雜志, 2019, 42(6): 405-412.
13. Naidoo J, Wang X, Woo KM, et al. Pneumonitis in patients treated with anti-programmed death-1/programmed death ligand 1 therapy. J Clin Oncol, 2017, 35(7): 709-717.

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Chinese Journal of Respiratory and Critical Care Medicine

帕博利珠單抗致免疫相關性肺炎一例及診治分析

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