摘要
目的分析免疫检查点抑制剂(ICIs)和肿瘤靶向药物相关的皮肤不良反应。方法回顾性分析22例免疫检查点抑制剂或各种肿瘤靶向药物相关的以皮肤表现为主的不良反应的病例相关资料。结果22例患者发生皮肤不良反应距首次使用靶向药或ICIs的时间为1 d~4年,平均发病时间为7个月。CTCAE 3级20例(90.91%),CTCAE 4级2例(9.09%)。CTCAE 3级中18例(90.00%)主要表现为红斑、丘疹,3例(15.00%)累及粘膜;CTCAE 4级的2例患者均诊断为大疱表皮松解症型药疹,同时患者还有炎症指标升高、肝功能异常等表现。其中8例患者完善皮损病理检查,出现的大疱性类天疱疮、银屑病、穿通性胶原病等病理表现与特发性疾病的病理表现相似。所有患者经过抗过敏、抗炎、丙种球蛋白冲击等治疗后均好转出院。结论免疫检查点抑制剂及靶向药导致的皮肤不良反应表现多样,住院病人中以CTCAE 3~4级为主,经过激素及常规治疗疗效较好。临床上需早发现早诊断早干预。目前暂无较好方法可以预测该不良反应的发生。
Objective To analyze cutaneous adverse reactions induced by immune checkpoint inhibitors and targeted antitumor drugs.Methods We retrospectively analyzed the clinical data of 22 cases of cutaneous adverse reactions caused by molecular targeted antitumor agents and immune checkpoint inhibitors.Results The time between the occurrence of skin adverse reactions and the first use of targeted drugs or ICIs ranged from 1 day to 4 years,with an average of 7 months.Inpatients with CTCAE grades 3 and 4 accounted for 90.91%and 9.09%,respectively.Majority of CTCAE-grade 3 patients(90.00%)mainly presented with erythema and papules,and 15.00%of patients had mucous involvement.Two CTCAE-grade 4 patients were diagnosed with drug-induced bullosa epidermolysis,accompanied by elevated inflammatory markers and abnormal liver function.The pathological findings of 8 patients with bullous pemphigoid,psoriasis or perforating collagen disease were similar to those of idiopathic diseases.All patients were discharged from hospital following the treatments with anti-allergy,anti-inflammatory and intravenous immunoglobulin therapy.Conclusions The cutaneous adverse reactions induced by immune checkpoint inhibitors and targeted drugs are mainly CTCAE grades 3 and 4 in inpatients,exhibiting various manifestations.Glucocorticoids and conventional treatments are effective.It is crucial to early diagnose and treat the skin adverse reactions.So far there is no good method to predict the development of drug adverse reactions.
作者
木葵
周星雨
李亚萍
MU Kui;ZHOU Xingyu;LI Yaping(Second Xiangya Hospital ofCentral South University,Changsha 410000,China)
出处
《皮肤性病诊疗学杂志》
2023年第6期539-543,共5页
Journal of Diagnosis and Therapy on Dermato-venereology
基金
国家自然科学基金面上项目(81472881)
长沙市自然科学基金(kq2208323)。
关键词
靶向药物
免疫检查点抑制剂
皮肤不良反应
targeted drug
immune checkpoint inhibitors
dermal adverse reaction
