真实世界中免疫检查点抑制剂导致免疫相关不良反应病例分析

Analysis of immune-related adverse events associated with immune checkpoint inhibitorsin the real world

目的:探讨免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)导致的免疫相关不良反应(immune-related adverse events, irAEs)的发生情况。方法:收集并分析2018年1月至2021年3月我院irAEs的具体情况,包括基本资料、用药情况、不良反应具体情况、治疗情况等。结果:63例irAEs,包括肺毒性3例、肝脏毒性9例、皮肤毒性23例、内分泌毒性15例、神经毒性4例、肾毒性3例、胃肠毒性1例、心脏毒性2例、血液毒性1例、眼毒性2例。男性47例,女性16例,中位发病年龄61岁,不良反应中位发生时间6.6周,17例需要大剂量糖皮质激素治疗。毒性级别1-2级49例,3-4级13例,5级1例。少见irAEs 14例,1例死于心肌炎。结论:irAEs涉及的器官或系统较多,多数在3级以下。常见不良反应预后较好。少见irAEs中,心肌炎可能导致患者死亡,需要临床予以重视。

Objective: Explore the occurrence of immune-related adverse events(irAEs) caused by immune checkpoint inhibitors(ICIs).Methods:The specific information of irAEs in our hospital from January 2018 to March 2021 was collected and analyzed, including basic information, drug use, specific adverse reactions, treatment.Results:63 cases of irAEs, including lung toxicity(3 cases),liver toxicity(9 cases),skin toxicity(23 cases),endocrine toxicity(15 cases),neurotoxicity(4 cases),renal toxicity(3 cases),gastrointestinal toxicity(1 case),cardiac toxicity(2 cases),blood toxicity(1 case) and ocular toxicity(2 cases).There were 47 males and 16 females, the median age of onset was 61 years old, and the median time of adverse reactions was 6.6 weeks.17 patients required high-dose glucocorticoid therapy.According to the toxicity grade, there were 49 cases of 1-2 grade, 13 cases of 3-4 grade and 1 case of 5 grade.Among the 63 cases of irAEs, 14 cases were rare, and 1 case died of explosive myocarditis.Conclusion:IrAEs involves more organs or systems, most are below 3 grade.Common irAEs have a good prognosis.In rare irAEs, explosive myocarditis which may lead to death of patients and requires clinical attention.