免疫检查点抑制剂致免疫相关性膀胱炎1例并文献复习

Immune-related cystitis associated with immune checkpoint inhibitor:a case report and review of literature

目的探讨免疫检查点抑制剂(immune checkpoint inhibitor,ICI)在晚期肝内胆管腺癌伴多发转移患者治疗中的罕见不良事件。方法使用帕博利珠单抗、特瑞普利单抗和伊匹木单抗治疗1例晚期肝内胆管腺癌患者,观察治疗期间患者病情变化,分析该患者的临床表现和实验室、影像学及组织病理学检查结果,调整治疗方案,并对该病例资料进行复习。结果ICI治疗33个周期后,患者出现典型尿路刺激症状并伴随腹泻,经尿常规、膀胱镜及组织病理学检查考虑免疫相关性膀胱炎,停用ICI并应用激素治疗后症状缓解,但激素减量过程中出现症状反复。结论在使用ICI时,应关注患者症状、体征、实验室指标变化,加强ICI毒性认识,做到免疫相关不良事件的早识别、早诊断、早治疗。

Objective To investigate the rare adverse events of immune checkpoint inhibitor(ICI)in the treatment of advanced intrahepatic cholangiocarcinoma with multiple metastases.Method A patient with advanced intrahepatic cholangiocarcinoma was treated with pembrolizumab,toripalimab and ipilimumab.The changes of patient's condition was observed during the treatment.The clinical manifestations,laboratory,imaging and histopathological results of the patient were analyzed,and the treatment plan was adjusted.The data of the case were reviewed.Result After 33 cycles of ICI treatment,the patient developed typical urinary irritation symptoms accompanied with diarrhea.After urinalysis,cystoscopy and histopathological examination,the immune-related cystitis was considered.The symptoms were relieved after discontinuing ICI and starting hormone treatment,but reversed in the process of hormone reduction.Conclusion When using ICI,we should pay attention to the changes of symptoms,signs and laboratory indexes of patients,strengthen the knowledge of ICI toxicity,and achieve early identification,early diagnosis and early treatment of immunerelated adverse events.