布地奈德雾化吸入治疗PD-1/PD-L1抑制剂致免疫相关性肺炎的疗效

Clinical effect of budesonide aerosol inhalation in the treatment of immune associated pneumonia induced by PD-1/PD-L1 inhibitor

目的 观察布地奈德雾化吸入治疗程序性细胞死亡蛋白受体-1/程序性细胞死亡蛋白配体-1(PD-1/PD-L1)抑制剂致免疫相关性肺炎(IMP)的临床疗效。方法 选取江西省肿瘤医院2021年1月—2022年6月收治的60例PD-1/PD-L1抑制剂致IMP患者作为研究对象,按照随机数字表法分为对照组(n=30)与治疗组(n=30)。患者入院后均给予常规治疗。对照组加用0.9%氯化钠溶液雾化吸入治疗,治疗组加用吸入用布地奈德混悬液雾化吸入治疗,2组均连续治疗14 d。比较2组临床疗效,症状(咳嗽、咳痰、发热、气喘、肺部啰音)消失时间,影像学检查异常率,治疗前、治疗14 d后淋巴细胞百分比(LYM)、白细胞计数(WBC)、嗜酸粒细胞百分比(EOS)。结果 治疗组治疗总有效率较对照组更高(90.00%vs. 66.67%,χ^(2)=4.812,P=0.028)。治疗组咳嗽、咳痰、发热、气喘、肺部啰音消失时间较对照组更短(P<0.01)。治疗14 d后,治疗组影像学检查结果总异常率低于对照组(3.33%vs. 20.00%,χ^(2)=4.043,P=0.044)。治疗14 d后,2组LYM较治疗前升高,WBC、EOS较治疗前降低,且治疗组变化幅度大于对照组(P<0.01)。结论 布地奈德雾化吸入治疗PD-1/PD-L1抑制剂致IMP患者可增强疗效,快速改善患者症状,加快肺部病灶吸收,减轻气道炎症,维持机体免疫平衡。

Objective To investigate the effect of budesonide aerosol inhalation in the treatment of IMP induced by PD-1/PD-L1 inhibitor.Methods From January 2021 to June 2022,a total of 60 patients with IMP induced by PD-1/PD-L1 inhibitor were selected in Jiangxi Cancer Hospital,and they were divided into the control group(30 cases)and the treatment group(30 cases)according to the random number table method.Both groups were given routine treatment,and patients in the control group were added with atomization inhalation of 0.9%sodium chloride solution,and patients of the treatment group were added with budesonide aerosol inhalation,both groups were treated for 14 days.Clinical efficacy,symptom(including cough,expectoration,fever,asthma,lung rales)disappearance time,abnormal rate of imaging examination and LYM,WBC,EOS before and after 14 days of treatment were compared between the two groups.Results The total effective rate of the treatment group was higher than that of the control group(90.00%vs.66.67%,χ^(2)=4.812,P=0.028).The disappearance time of cough,expectoration,fever,asthma,lung rales in the treatment group were shorter than those in the control group(P<0.01).After 14 days of treatment,the total abnormal rate of imaging examination in the treatment group was lower than that in the control group(3.33%vs.20.00%,χ^(2)=4.043,P=0.044).After 14 days of treatment,LYM of the two groups was higher than that before treatment,WBC,EOS were lower than those before treatment,and the change range of the treatment group was greater than that of the control group(P<0.01).Conclusion Budesonide aerosol inhalation can enhance curative effect in the treatment of IMP induced by PD-1/PD-L1 inhibitor,which can quickly improve the symptoms of patients,accelerate the absorption of lung lesions,reduce airway inflammation and maintain the immune balance of the body.