CT用于免疫检查点抑制剂相关性肺炎

CT for immune checkpoint inhibitor-related pneumonitis

目的评价CT在免疫检查点抑制剂相关性肺炎(CIP)诊疗中的价值。方法观察7例经程序性细胞死亡蛋白1(PD-1)/程序性死亡配体1(PD-L1)治疗后诊断CIP患者的临床资料及CT影像学表现,评价CT用于诊疗CIP的价值。结果7例CIP的临床分级包括2级1例、3级4例及4级2例;均见多发病灶累及双肺多叶、多段;3例病灶呈对称分布,4例呈非对称分布。影像学分型包括磨玻璃型3例、实变型2例(多发斑片亚型、肺实变亚型各1例)及网格型2例;5例伴胸膜增厚,5例纵隔淋巴结受累,3例伴牵拉性支气管扩张,2例伴小叶间隔增厚,2例伴多发小叶中心结节,1例伴胸腔积液。结论CT结合免疫检查点抑制剂治疗史可辅助诊断CIP,为确定治疗方案提供依据。

Objective To observe the value of CT in diagnosis and treatment of immune checkpoint inhibitor-related pneumonitis(CIP).Methods Clinical data and CT imaging findings of 7 patients diagnosed with CIP after treated with programmed cell death protein 1(PD-1)/programmed death ligand 1(PD-L1)were observed.The value of CT for diagnosis and treatment of CIP was evaluated.Results There were 1 case of clinical grade 2,4 cases of grade 3 and 2 cases of grade 4 among 7 cases of CIP,with lesions involved multiple lobes and segments of both lungs.Symmetrical distribution of lesions were found in 3 cases,while asymmetric distribution was observed in 4 cases.The imaging types included 3 cases of ground-glass type,2 cases of consolidation type(1 case of multiple patch subtype and 1 case of pulmonary consolidation subtype)and 2 cases of grid type.Five cases were found with pleural thickening,5 with mediastinal lymph nodes involvements,3 with tractive bronchiectasis,2 with interlobular septal thickening,2 with multiple interlobular central nodules and 1 case with pleural effusion.Conclusion CT combined with the history of immune checkpoint inhibitor treatment could assist diagnosis of CIP and provide basis for treatment plan.