摘要
目的:探讨利妥昔单抗(RTX)致间质性肺疾病(ILD)(RTX-ILD)的发病机制、临床表现、诊断、鉴别诊断、治疗和预后。方法:1例19岁男性患者,确诊经典型霍奇金淋巴瘤2+年,1年前疾病复发,复发后行自体造血干细胞移植(HSCT),移植后2个月开始每月以375mg·m-2 RTX维持化疗,期间纵隔复发行纵隔残留病灶放疗10次,第3次RTX维持治疗后第8天,患者出现活动后呼吸困难,伴发热、咳嗽、胸闷和乏力。胸部CT提示双肺多发斑片状磨玻璃影,血气分析提示低氧血症。先后给予抗细菌及抗真菌治疗,效果均不理想。后续反复多次行病原学检查均为阴性,支气管镜检查仍未见明显异常,考虑到RTX-ILD的可能,立即停用RTX并静脉给予40mg·d-1甲强龙治疗。结果:5d后患者症状好转,后续激素改为口服并逐渐减量至停用。结论:RTX-ILD相对罕见,临床表现缺乏特异性,治疗以激素为主,对激素敏感者预后较好,激素不敏感者预后较差。
Objective:To discuss the pathogenesis,clinical manifestations,diagnosis,differential diagnosis,treatment,and prognosis of the patient with rituximab(RTX)induced interstitial lung disease(ILD)(RTX ILD).Methods:A male patient aged19years old was confirmed as classical Hodgkin’s lymphoma more than2years ago,and received autologous hemopoietic stem cell transplantation(HSCT)when the disease recurred1year ago.Two months after HSCT,the maintenance chemotherapy was given every month with375mg·m-2RTX,but the mediastinal recurrence appeared during the period,then the mediastinal residual lesion radiotherapy was done for10times.However,8d after the third RTX chemotherapy,the patient experienced post exercising tachypnea,fever,cough,chest congestion,and limb weakness.The chest CT scanning results suggested ground gloss opacity on both lungs,and blood gas analysis suggested a hypoxemia.Neither antibacterial nor antifungal treatment worked well.Afterwards,the sequential etiological examination showed the negative results,and the bronchoscope examination showed the normal results as well.Considering about the possibility of RTX ILD,RTX was stopped immediately and turned to intravenous infusion of methylprednisolone40mg per day.Results:Five d later,the symptoms of the patients were improved,and the follow up methylprednisolone was changed to oral and gradually reduced to discontinuation.Conclusion:RTX ILD is relatively rare,and its clinical manifestations lack specificity.Hormonotherapy is the main method in treatment of RTX ILD.The patients sensitive to hormonotherapy have better prognosis than those insensitive to hormonotherapy.
作者
彭印印
陈礼平
刘林
陈建斌
陈亚娟
韩晓黎
肖青
PENG Yinyin;CHEN Liping;LIU Lin;CHEN Jianbin;CHEN Yajuan;HAN Xiaoli;XIAO Qing(Department of Hematology, First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China;Department of Respiratory Medicine, First Affiliated Hospital, Chongqing Medical University, Chongqing 400016, China)
出处
《吉林大学学报（医学版）》
CAS
CSCD
北大核心
2017年第6期1260-1264,共5页
Journal of Jilin University：Medicine Edition
基金
重庆市卫生局重点项目资助课题(2013-1-013)
关键词
利妥昔单抗
淋巴肿瘤
间质性肺疾病
造血干细胞移植
感染
rituximab
lymphoma
interstitial lung disease
hemopoietic stem cell transplantation
infection
