免疫检查点抑制剂治疗晚期恶性肿瘤引起相关肺炎的临床分析

Clinical analysis of immune checkpoint inhibitors-related pneumonitis in patients with malignant tumors

目的分析免疫检查点抑制剂(ICIs)相关性肺炎(CIP)的临床特征、处理策略及转归。方法收集本院2018年7月至2021年7月接受ICIs治疗后诊断为CIP的晚期肿瘤患者的临床资料,分析CIP患者的临床特征、影像学表现、治疗及转归。结果329例接受ICIs治疗的恶性肿瘤患者中,有14例发生CIP,发生率为4.1%,ICIs用药至CIP发生的中位时间为71 d(4~176 d)。G1、G2、G3、G4的比例分别为7%、72%、14%、7%。首发症状以咳嗽、咳痰、胸闷、发热、乏力多见。影像学图像表现为磨玻璃样改变、斑片及条索影、网格影、肺实变的比例分别为50%、29%、14%、7%。使用糖皮质激素治疗的13例患者中有11例好转,2例病情控制欠佳。有3例重新启动免疫治疗。结论CIP发生率较低,无特征性临床症状,糖皮质激素是最重要的治疗手段。

AIM To investigate the clinical features,therapeutic strategy and prognosis of immune checkpoint inhibitors(ICIs)-related pneumonitis(CIP)in patients with advanced malignant tumors patients.METHODS The data of patients with CIP who received ICIs from July 2018 to July 2021 were collected,and the clinical features,imaging characteristics,treatment and prognosis of the patients were analyzed.RESULTS Among 329 malignant tumors patients who received ICIs,14 cases of CIP occurred and the incidence was 4.1%.The median time from the use of ICIs to the occurrence of CIP was 71 days(4 to 176 days).The proportions of G1,G2,G3 and G4 were 7%,72%,14%and 7%,respectively.Primary symptoms were cough,expectoration,chest tightness,fever,fatigue and so on.According to the imaging characteristics,the proportions of ground glasses,patchy shadows,grid shadows and consolidation shadow were 50%,29%,14%and 7%,respectively.Thirteen patients received glucocorticoid treatment.The condition of 11 patients improved and 2 patients uncontrolled.Three patients were challenged after recovery from initial CIP.CONCLUSION The incidence of CIP was low and the patients were lack of specificity in clinical manifestations,and rational application of glucocorticoid therapy was key to good effects.