利妥昔单抗相关间质性肺炎50例临床分析

Rituximab-induced interstitial pneumonia in 50 cases

目的总结利妥昔单抗相关间质性肺炎(interstitial pneumonia,IP)的临床特点,探讨糖皮质激素治疗利妥昔单抗相关IP的效果。方法回顾性分析50例利妥昔单抗相关IP患者的临床资料。结果50例中位发病时间为利妥昔单抗治疗4个周期后;临床表现以咳嗽、乏力、发热伴呼吸困难为主;实验室检查显示红细胞沉降率、乳酸脱氢酶、C反应蛋白水平升高,白细胞计数、降钙素原正常;第1秒用力呼气容积(forced expiratory volume in one second,FEV1)占预计值百分比(FEV1%pred)、pa(O2)降低;支气管肺泡灌洗液细胞总数增加39例,淋巴细胞比率增高49例,肺泡灌洗液中未检出病原微生物;胸部高分辨率CT表现为明显的磨玻璃样改变;明确诊断后给予甲泼尼龙1~2 mg/(kg·d)治疗,5~7 d后复查胸部高分辨率CT显示45例磨玻璃影基本吸收,5例未见明显吸收;47例病情稳定出院后口服醋酸泼尼松40 mg/d维持治疗,5例磨玻璃影未吸收者中3例病情恶化,其中1例死亡。结论利妥昔单抗相关IP临床表现及CT影像学表现及血清学标志物缺乏特异性,糖皮质激素治疗有较好疗效。

Objective To summarize the clinical features of rituximab-induced interstitial pneumonia(IP),and to investigate the effect of glucocorticoid on rituximab-induced IP.Methods The clinical data of 50 patients with rituximab-induced IP were retrospectively analyzed.Results The median onset time was after 4 cycles of rituximab treatment.The main clinical manifestations were cough,fatigue,fever and dyspnea.Laboratory examination showed that the erythrocyte sedimentation rate,lactate dehydrogenase and C-reactive protein levels increased,the leukocyte count and procalcitonin were normal,and the forced expiratory volume in one second as a percentage of predicted value and pa(O2)decreased.The total number of leukocytes in bronchoalveolar lavage fluid increased in 39 cases,and the percentage of lymphocytes increased in 49 cases.No pathogenic organisms were detected in the bronchoalveolar lavage fluid.Chest high resolution CT showed obvious ground glass changes,which were basically absorbed in 45 cases and not obviously adsorbed in 5 cases after the administration of methylprednisolone 1 to 2 mg/(kg·d)for 5 to 7 days.Forty-seven patients received maintenance treatment with oral prednisone acetate 40 mg/d after discharged from hospital,and three patients with no obvious absorbed changes were deteriorated,in which one patient died.Conclusion Rituximab-induced IP lacks the clinical,imaging and serological markers specificities.Glucocorticoids can achieve a good result.