摘要
目的:研究程序性细胞死亡蛋白1(programmed death-1,PD-1)及其配体(programmed death-ligand 1,PD-L1)的抑制剂(PD-1/PD-L1抑制剂)与结核病的关系,提高对肿瘤患者使用PD-1/PD-L1抑制剂治疗期间出现活动性结核病的认识。方法:回顾性分析2017年2月至2022年10月深圳市第三人民医院肺病二科诊治的5例使用PD-1/PD-L1抑制剂治疗的恶性肿瘤合并活动性肺结核患者的临床资料、诊断过程及预后。同时,查阅2016年1月1日至2022年6月25日PubMed、Cochrane Library、中国知网发布的与使用PD-1/PD-L1抑制剂治疗的结核病相关文献报告,总结应用PD-1/PD-L1抑制剂中出现活动性结核病的临床特点。结果:5例患者中,男性4例,女性1例,在PD-1/PD-L1抑制剂使用前均未进行结核病筛查,在使用PD-1/PD-L1抑制剂治疗3~12个月时出现活动性肺结核,并经病原学检查确诊。患者抗结核治疗后,2例好转,2例治愈,1例病亡;2例重启PD-1/PD-L1抑制剂治疗。同时,通过数据库检索到12篇文献,包含14例患者,使用PD-1/PD-L1抑制剂出现活动性结核病的中位时间为5个月,11例发生活动性肺结核,3例发生肺外结核;10例患者抗结核治疗后好转,2例病亡,2例治疗结局不详;7例患者重启PD-1/PD-L1抑制剂治疗。结论:使用PD-1/PD-L1抑制剂的过程中需要警惕活动性结核病的发生,活动性结核病在抗结核治疗病情好转后重启PD-1/PD-L1抑制剂的治疗是相对安全的。
Objective:To study the relation of tuberculosis and inhibitors of programmed death protein-1 and its ligand(PD-1/PD-L1),to improve the understanding of development of active tuberculosis in tumor patients treated with PD-1/PD-L1 antibody.Methods:The clinical characteristics and treatment outcomes of 5 patients who developed active tuberculosis when using PD-1/PD-L1 inhibitors for their malignant tumor from February 2017 to October 2022 were retrospectively analyzed.Literature associated tuberculosis related to PD-1/PD-L1 inhibitors from 2016 January 1st to 2022 June 25th included in PubMed,Cochrane Library and CNKI was reviewed.Reported clinical features of active tuberculosis in patients with PD-1/PD-L1 inhibitors therapy were summarized.Results:Among 5 patients,4 were male and 1 was female.None of them had been screened for tuberculosis before the use of PD-1/PD-L1 inhibitors.Active pulmonary tuberculosis developed at 3rd to 12th months after administration of PD-1/PD-L1 inhibitors.All patients were diagnosed with active pulmonary tuberculosis by etiological examination.After anti-tuberculosis treatment,2 patients got improved,2 patient was cured and 1 patient died;2 patients restarted using PD-1/PD-L1 inhibitors.Among 14 patients reported in 12 literature,the median time of tuberculosis onset was the 5th month after administration of PD-1/PD-L1 inhibitors.Eleven patients were active pulmonary tuberculosis and 3 were extrapulmonary tuberculosis;10 patients got improved after anti-tuberculosis treatment,2 patients died and 2 with unknown outcomes.There were 7 patients restarted PD-1/PD-L1 inhibitors therapy.Conclusion:It is necessary to be alert to the occurrence of active tuberculosis during the treatment of PD-1/PD-L1 inhibitors.It is relatively safe to restart PD-1/PD-L1 inhibitors therapy after tuberculosis is controlled.
作者
任坦坦
詹森林
王玉香
喻宏
郑俊峰
杨敏
邓国防
张培泽
Ren Tantan;Zhan Senlin;Wang Yuxiang;Yu Hong;Zheng Junfeng;Yang Min;Deng Guofang;Zhang Peize(Department Two of Pulmonary Medicine,Shenzhen Third People’s Hospital,Shenzhen 518112,China;Department of Pathology,Shenzhen Third People’s Hospital,Shenzhen 518112,China)
出处
《结核与肺部疾病杂志》
2023年第1期27-32,共6页
Journal of Tuberculosis and Lung Disease
基金
深圳市第三人民医院院内项目(G2021015)。
