纳武利尤单抗致免疫相关性结肠炎文献回顾分析

Literature retrospective analysis of immune-related colitis induced by nivolumab

目的:分析纳武利尤单抗致结肠炎的临床特点及治疗方案,为其安全合理使用提供依据。方法:检索PubMed、Embase、Elsevier、SpringerLink、中国知网、万方和维普数据库,对纳入病例的基本信息和结肠炎发生特点等进行分析。结果:共纳入27例患者,来自5个国家,患者中位年龄64岁(42~89岁)。不良反应症状包括腹泻、腹痛、便血等,主要发生在给药1~19次后;10例患者检查C反应蛋白水平,结果显示均高于正常范围;96.30%(26/27)的患者行消化道内镜检查,主要表现为结肠黏膜发红斑、血管纹理减少、糜烂和溃疡,组织病理学检查中70.37%(19/27)的患者提示慢性炎症,37.04%(10/27)的患者有隐窝脓肿形成。96.30%(26/27)的患者停用纳武利尤单抗并给予糖皮质激素、美沙拉嗪、英夫利昔单抗治疗后症状缓解。结论:临床应关注纳武利尤单抗相关结肠炎,针对发生腹泻、腹痛、便血的患者,可结合内镜及影像学检查排除其他病因并给予治疗,提高对免疫相关结肠炎的识别和管理水平。

Objective:To analyze the clinical characteristics and treatment of nivolumab-induced colitis so as to provide evidence for the safe and reasonable use of nivolumab.Methods:Case reports of nivolumab-induced colitis were collected from the databases including PubMed,Embase,Elsevier,Springer Link,CNKI,Wanfang and VIP and analyzed in terms of the general information of the patients and the characteristics of colitis.Results:A total of 27 patients from 5 countries were included.The median age was 64 years old(42–89 years old).Symptoms of adverse reactions included diarrhea,abdominal pain and hematochezia,which mainly occurred after 1–19 doses.C-reactive protein level was available in 10 patients and all above the normal range.96.30%(26/27)of the patients underwent endoscopic examination of the digestive tract,mainly manifested as erythema,reduced vascular texture,erosion and ulceration.In patients with histopathological examination,70.37%(19/27)of them showed chronic inflammation,and 37.04%(10/27)had crypt abscess.96.30%(26/27)of patients improved after stopping nivolumab and accepting glucocorticoid,mesalazine and infliximab.Conclusion:Clinicians should pay attentions to nivolumab-induced colitis.Patients with diarrhea,abdominal pain and hematochezia should be given endoscopy and imaging examination to exclude other causes and receive treatment in order to improve the recognition and management of immune-associated colitis.