摘要
目的分析纳武利尤单抗相关孤立性促肾上腺皮质激素缺乏症(IAD)的临床特点。方法以“纳武利尤单抗或纳武单抗、孤立性促肾上腺皮质激素缺乏症或促肾上腺皮质激素缺乏”和“nivolumab、isolated adrenocorticotropic hormone deficiency or adrenocorticotropic hormone deficiency”为检索词,检索1998年9月至2021年10月中国知网、万方、维普和PubMed、Web of Science数据库的纳武利尤单抗相关IAD的个案报道,提取相关信息进行描述性分析。结果共筛选出个案报道25篇,涉及纳武利尤抗相关IAD 29例,男性20例,女性9例,其中日本籍患者19例(66%);纳武利尤单抗单药治疗27例(93%)。26例(90%)患者在纳武利尤单抗治疗后300 d内发生IAD。临床症状以乏力、纳差多见,且易合并甲状腺疾病(14例,48%),早期实验室检查异常为血钠降低22例(76%)及嗜酸性粒细胞比率升高12例(41%)。28例(97%)患者长期服用氢化可的松替代治疗,除1例因原发病进展死亡外,其余均预后良好。结论纳武利尤单抗相关IAD可能存在地域或种族差异,治疗期间应密切关注患者甲状腺功能、血钠水平及嗜酸性粒细胞比率,氢化可的松替代治疗后预后良好。
AIM To analyze the clinical characteristics of nivolumab-related isolated adrenocorticotropic hormone deficiency(IAD).METHODS“Nivolumab,IAD or adrenocorticotropic hormone deficiency”were selected as the keywords.The case reports of nivolumab-related IAD were collected by CNKI,Wanfang,VIP,PubMed and Web of Science databases from September 1998 to October 2021,and extracted relevant data for descriptive analysis.RESULTS A total of 25 case reports were screened,involving 29 cases of nivolumab-related IAD,20 males and 9 females,including 19 Japanese patients(66%),and 27 cases(93%)were treated with nivolumab alone.The IAD occurred in 26 patients(90%)within 300 days after nivolumab treatment.The clinical symptoms of asthenia and anorexia were common,and thyroid diseases were easy to be combined(14 cases,48%).Early laboratory abnormalities included decreased serum sodium in 22 cases(76%)and increased eosinophil ratio in 12 cases(41%).Twenty-eight patients(97%)took hydrocortisone replacement therapy for a long time,and all patients had good prognosis except one patient who died due to the progression of the primary disease.CONCLUSION Nivolumab-related IAD may be regional or ethnic differences.The thyroid function,blood sodium level and eosinophil ratio should be monitored during the treatment,and the prognosis is good after hydrocortisone replacement therapy.
作者
胡晓霞
竺晶
刘霞
李洁
神兴伟
HU Xiao-xia;ZHU Jing;LIU Xia;LI Jie;SHEN Xing-wei(Department of Geriatrics,Lanzhou University Second Hospital,Lanzhou GANSU 730030,China;Lanzhou University,Lanzhou GANSU 730000,China)
出处
《中国新药与临床杂志》
CAS
CSCD
北大核心
2023年第3期204-208,共5页
Chinese Journal of New Drugs and Clinical Remedies
基金
甘肃省自然科学基金(20JR10RA750)。