摘要
目的收集并总结免疫检查点抑制剂(ICI)相关性结肠炎的临床特征。方法收集2021年1月至2022年2月上海中医药大学附属曙光医院收治的6例ICI相关性结肠炎患者的临床资料,分析并总结ICI相关性结肠炎的病程特点、临床表现、内镜及组织学特点、治疗方法以及患者预后转归情况。结果6例患者中男性5例,女性1例,ICI相关性结肠炎诊断年龄为48~70岁。6例患者在接受2~6次抗程序性死亡受体-1(Programmed death-1,PD-1)及其配体(Programmed death-ligand 1,PD-L1)疗程后,出现ICI相关性结肠炎,中位疗程为4.1个;首次抗PD-1/PD-L1治疗后,ICI相关性结肠炎起病时间为14~84 d,中位时间为53 d。6例患者中,4例为2级ICI相关性结肠炎,且病变在左半结肠,3级、4级各1例,病变范围均为全结肠。患者的症状主要为腹泻、腹痛、黏液血便。结肠镜下主要表现为弥漫而连续性的黏膜糜烂、充血和水肿,2例3~4级ICI相关性结肠炎患者结肠镜下可见多发不规则溃疡。黏膜活检病理均表现为黏膜活动性炎症伴隐窝炎、隐窝脓肿。6例患者完成结肠镜后,均接受了糖皮质激素治疗,其中2例3~4级ICI相关性结肠炎患者静脉使用甲基泼尼松龙3 d临床应答不佳,升级为英夫利昔单抗(IFX)治疗。6例患者均未重启ICI治疗。结论ICI相关性结肠炎有其相应的ICI治疗史以及临床、内镜、组织学特征,应根据患者症状予以分级治疗。糖皮质激素是最常用的治疗药物,应答不佳时,应尽早开启生物制剂治疗。
Objective To collect and summarize the clinical characteristics of immune checkpoint inhibitor(ICI)-related colitis.Methods The clinical data of 6 patients with ICI-related colitis treated in Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine from January 2021 to February 2022 were collected,and the course characteristics,clinical manifestations,endoscopic and histological characteristics,treatment methods and prognosis of ICI-related colitis were analyzed and summarized.Results Among the 6 patients,there were 5 males and 1 female.The age at diagnosis of ICI-related colitis was 48~70 years old;6 patients developed ICI-related colitis after receiving 2~6 anti-PD-1/PD-L1 courses,with a median course of 4.1 months;after the first anti-PD-1/PD-L1 treatment,the onset time of ICI-related colitis was 14~84 days,and the median time was 53 days.Among the 6 patients,4 cases were grade 2 ICI-related colitis,and the lesion was the left colon;1 case was grade 3 and another was grade 4,and the lesion range was the whole colon.The main symptoms of the patients were diarrhea,abdominal pain and mucus and bloody stool.Under colonoscopy,the patients mainly showed diffuse and continuous mucosal erosion,congestion and edema.Multiple irregular ulcers were seen in 2 patients with grade 3~4 ICI-related colitis.The pathological manifestations of mucosal biopsy were mucosal active inflammation with crypt inflammation and crypt abscess.Six patients received glucocorticoid treatment after colonoscopy.Among them,two patients with grade 3~4 ICI-related colitis had poor clinical response to intravenous methylprednisolone for 3 days and were upgraded to infliximab(IFX).All 6 patients did not restart ICI treatment.Conclusion ICI-related associated colitis has its corresponding ICI treatment history and clinical,endoscopic and histological characteristics.Graded treatment should be given according to the patient′s symptoms.Glucocorticoid is the most often used medicine.If the response is poor,biological agent tr
作者
卢璐
冯煜
阎良
Lu Lu;Feng Yu;Yan Liang(Department of Gastroenterology,Longhua Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200030,China;Department of General Surgery,Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine,Shanghai 200021,China)
出处
《实用药物与临床》
2024年第1期45-49,共5页
Practical Pharmacy and Clinical Remedies
基金
上海申康医院发展中心临床科技创新项目(SHDC 12021120)。
关键词
免疫检查点抑制剂
免疫治疗相关不良反应
结肠炎
临床特征
Immune checkpoint inhibitors
Immune treatment-related adverse events
Colitis
Clinical features
