肺癌患者免疫检查点抑制剂相关性肺炎的临床分析

Clininal analysis of immune checkpoint inhibitor-related pneumonia in patients with lung cancer

目的分析肺癌患者免疫检查点抑制剂相关性肺炎(CIP)的临床特征。方法回顾性收集2017年1月至2020年12月复旦大学附属中山医院收治的CIP患者的病例资料,对患者的基本资料、临床表现、影像学资料、实验室检查结果、治疗和预后进行分析。结果19例患者发生CIP,男女比例为18:1,中位年龄为65岁(41~74岁)。14例患者使用程序性死亡蛋白-1(PD-1)抑制剂,5例患者使用程序性死亡蛋白配体-1(PD-L1)抑制剂。发生CIP的中位时间为3.5个月。15例患者出现呼吸道症状:呼吸困难11例,咳嗽9例,胸闷8例,发热4例,咳痰4例,咳血2例。胸部CT主要表现为间质性肺炎,其中8例为隐源性机化性肺炎(COP),7例为非特异性间质性肺炎(NSIP),2例为急性间质性肺炎,2例为过敏性肺炎。发生CIP时C反应蛋白、红细胞沉降率、乳酸脱氢酶较发生肺炎前升高,差异有统计学意义。3例患者单纯随访观察,14例患者单纯应用糖皮质激素治疗,2例患者联合免疫抑制剂治疗,19例患者的肺炎病灶均较前吸收好转或稳定,5例重新启动免疫治疗。无CIP死亡病例。结论CIP主要发生于男性,发生缓慢,临床表现缺乏特异性,炎症指标多升高,影像学表现以NSIP、COP改变为主,及早识别、诊断和合理应用糖皮质激素治疗效果良好。

Objective To analyze the clinical features of immune checkpoint inhibitor-related pneumonia(CIP)in patients with lung cancer.Methods The case data of patients with CIP admitted to Zhongshan Hospital of Fudan University from January 2017 to December 2020 were retrospectively collected,and the basic data,clinical manifestations,imaging data,laboratory examination results,treatment and prognosis of the patients were analyzed.Results The ratio of male to female was 18:1,and the median age was 65 years(from 41 to 74 years).Fourteen patients received a programmed death protein-1(PD-1)inhibitor and five patients received a programmed death protein-ligand-1(PD-L1)inhibitor.The median time to CIP was 3.5 months.The respiratory symptoms of 15 patients were dyspnea in 11 cases,cough in 9 cases,chest tightness in 8 cases,fever in 4 cases,expectoration in 4 cases and hemoptysis in 2 cases.Chest CT findings mainly showed interstitial pneumonia,including 8 cases of implicit organizational pneumonia(COP),7 cases of non-specific interstitial pneumonia(NSIP),2 cases of acute interstitial pneumonia,and 2 cases of allergic pneumonia.C-reactive protein,erythrocyte sedimentation rate and lactate dehydrogenase were higher in CIP than before,and the difference was statistically significant.Follow-up observation was performed in 3 patients alone,14 patients were treated with glucocorticoid alone,2 patients were treated with immunosuppressant therapy,19 patients had stable or more absorption of pneumonia lesions,and 5 patients had restarted immunotherapy.There were no deaths from CIP.Conclusions CIP mainly occurs in men,with slow onset,lack of specificity in clinical manifestations,and increased inflammatory indicators.Imaging findings are mainly NSIP and COP changes.Early identification,diagnosis and rational application of glucocorticoid therapy have good effects.