免疫检查点抑制剂相关结肠炎的诊疗进展

Progress in diagnosis and treatment of immune checkpoint inhibitor-associated colitis

针对抗细胞毒T淋巴细胞相关抗原-4(cytotoxic T-lymphocyte antigen 4,CTLA-4)及程序性死亡受体-1及其配体(programmed cell death 1/programmed cell death-ligand 1,PD-1/PD-L1)的免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)已成为多种恶性肿瘤的标准治疗手段。ICIs导致的免疫相关不良事件(immune-related adverse events,irAEs)可发生于人体任何器官组织,虽然其中多数症状轻微,但若不能及时发现处理也将造成严重后果,甚至威胁生命。ICIs引起的腹泻及结肠炎是导致ICIs停用的最常见irAE之一,及时预防和管理ICIs相关结肠炎是肿瘤患者能否从免疫治疗中持续获益的重点。本文通过对ICIs相关结肠炎的流行病学、诊断依据、临床管理及研究进展进行阐述,旨在为临床医师及时发现、鉴别及管理ICIs相关结肠炎提供参考。

Immune checkpoint inhibitors(ICIs)targeting cytotoxic T-lymphocyte associated antigen-4(CTLA-4)and programmed cell death1/programmed cell death-ligand 1(PD-1/PD-L1)have been established as standard therapies for many malignancies.Immune-related adverse events(irAEs)caused by ICIs can occur in any organ or tissue in the body.Although symptoms are ordinarily mild,they can result in serious or even fatal outcomes if are not monitored and treated rapidly.Diarrhea and colitis caused by ICIs are the most common irAEs leading to discontinuation of ICIs.Timely prevention and management of immune-related colitis are required to ensure that cancer patients can benefit from immunotherapy.This article reviews the epidemiology,diagnosis,clinical management,and research progress of ICIassociated colitis,providing a reference for clinicians to aid the timely identification and treatment of this condition.