纳武利尤单抗致免疫相关性肾毒性文献回顾性分析

Literature analysis on immune-related nephritis induced by nivolumab

目的:探讨纳武利尤单抗致免疫相关性肾毒性的临床特点,旨在为其临床合理用药提供参考。方法:检索中国知网、维普、万方、PubMed以及Web of Science数据库,收集2015年3月至2021年12月关于纳武利尤单抗致免疫相关性肾毒性的文献进行分析。结果:纳武利尤单抗致免疫相关性肾毒性的个案报道共33例,中位发生时间为(3.0±5.5)个月,其临床表现主要为乏力、肢体水肿等伴肌酐升高,伴或不伴蛋白尿。病理学主要表现为急性肾小管间质性肾炎。29例患者经停药和(或)对症治疗后痊愈或好转,4例患者死亡。结论:纳武利尤单抗治疗过程中需关注患者的临床症状及肾功能,鉴别其可能导致的免疫相关性肾损伤,及时根据严重程度分级处理,并警惕再次给药后可能发生的复发风险。

OBJECTIVE To analyze the clinical characteristics of immune-related nephrotoxicity induced by nivolumab,and to provide reference for rational application of nivolumab in clinic.METHODS CNKI,VIP,Wanfang,PubMed and Web of Science databases were searched for immune-related nephrotoxicity induced by nivolumab from March 2015 to December 2021,and the data were further analyzed statistically.RESULTS A total of 33 cases of immune-related nephrotoxicity induced by nivolumab were identified and included.The median occurrence time of immune-related nephrotoxicity induced by nivolumab was(3.0±5.5)months.The main clinical characteristics were limb fatigue and edema with increased creatinine,with or without albuminuria.The main pathological findings were acute tubulointerstitial nephritis.Totally 29 patients improved after drug withdrawal and/or symptomatic treatment,and 4 patients died.CONCLUSION The clinical symptoms and renal function of patients identified with immune-related nephrotoxicity should be paid attention during the treatment of nivolumab.Patients with immune-related nephrotoxicity should be treated in time according to the severity,and the risk of recurrence after re-challenge therapy should be monitored.