帕博利珠单抗致免疫相关性肺炎一例及诊治分析_Chinese Journal of Respiratory and Critical Care Medicine

Authors：

陈子谓 ^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：

免疫检查点抑制剂; 免疫检查点抑制剂肺炎; 支气管镜冷冻肺活检

DOI：

10.7507/1671-6205.202107026

Video：

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目的提高免疫检查点抑制剂相关性肺炎（CIP）的早期诊断与治疗。方法对 1 例接受程序性死亡蛋白-1 单抗治疗的晚期肺腺癌患者继发免疫相关性肺炎的临床表现、影像学、微生物学、支气管镜检查、病理诊断及治疗过程进行回顾分析。结果该例患者经过支气管镜冷冻肺活检病理显示为机化性肺炎，早期诊断 CIP，临床分级 2 级，予停用免疫检查点抑制剂，同时给予口服强的松（按 1 mg· kg^–1· d^–1）治疗 2 周后症状好转，复查胸部 CT 见肺部病灶较前大部分吸收。结论 CIP 临床表现多样化，早期诊断困难；支气管镜检查尤其是经支气管镜冷冻肺活检有助早期 CIP 明确诊断，CIP 使用糖皮质激素治疗效果好。

Citation： 陈子谓, 廖槐, 匡煜坤, 唐可京. 帕博利珠单抗致免疫相关性肺炎一例及诊治分析. Chinese Journal of Respiratory and Critical Care Medicine, 2021, 20(9): 661-664. doi: 10.7507/1671-6205.202107026 Copy

1.	王汉萍, 郭潇潇, 周佳鑫, 等. 免疫检查点抑制剂相关肺炎的临床诊治建议. 中国肺癌杂志, 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.	陈玉玲, 赵静, 贾茹, 等. 程序性死亡蛋白-1 抑制剂 Pembrolizumab 致免疫相关肺炎一例并文献复习. 中华结核和呼吸杂志, 2017, 40(10): 736-743.
5.	中华医学会呼吸病学分会肺癌学组. 免疫检查点抑制剂相关肺炎诊治专家共识. 中华结核和呼吸杂志, 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, 黄慧, 徐作军. 经支气管镜冷冻肺活检在弥漫性间质性肺病诊断中的应用. 国际呼吸杂志, 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.	李一诗, 郭述良, 曹友德. 经支气管冷冻肺活检二例. 中华结核和呼吸杂志, 2016, 39(11): 905-907.
12.	中华医学会呼吸病学分会介入呼吸病学学组, 中国医师协会呼吸医师分会介入呼吸病学工作委员会. 经支气管冷冻活检技术临床应用专家共识. 中华结核和呼吸杂志, 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. 王汉萍, 郭潇潇, 周佳鑫, 等. 免疫检查点抑制剂相关肺炎的临床诊治建议. 中国肺癌杂志, 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. 陈玉玲, 赵静, 贾茹, 等. 程序性死亡蛋白-1 抑制剂 Pembrolizumab 致免疫相关肺炎一例并文献复习. 中华结核和呼吸杂志, 2017, 40(10): 736-743.
5. 中华医学会呼吸病学分会肺癌学组. 免疫检查点抑制剂相关肺炎诊治专家共识. 中华结核和呼吸杂志, 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, 黄慧, 徐作军. 经支气管镜冷冻肺活检在弥漫性间质性肺病诊断中的应用. 国际呼吸杂志, 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. 李一诗, 郭述良, 曹友德. 经支气管冷冻肺活检二例. 中华结核和呼吸杂志, 2016, 39(11): 905-907.
12. 中华医学会呼吸病学分会介入呼吸病学学组, 中国医师协会呼吸医师分会介入呼吸病学工作委员会. 经支气管冷冻活检技术临床应用专家共识. 中华结核和呼吸杂志, 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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帕博利珠单抗致免疫相关性肺炎一例及诊治分析

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