免疫检查点抑制剂相关肺炎的临床及影像学特点分析

Analysis of Clinical and Imaging Characteristics of Immune Checkpoint Inhibitor-Related Pneumonitis

目的总结分析免疫检查点抑制剂相关肺炎(CIP)的临床及影像学特点。方法回顾性分析使用免疫检查点抑制剂治疗的145例晚期恶性肿瘤患者临床资料及系列胸部CT图像,分析CIP的发生率、相关危险因素、发生时间、症状、影像学特征、CIP分级及转归。结果24例(16.6%)患者发生CIP,存在基础肺气肿及间质性肺疾病患者CIP发生率高,差异均有统计学意义(P值均<0.05)。发生CIP中位时间161天(61~316天),其中肺癌(LC)组的中位时间86天(17例,39~214天),非LC组的中位时间256天(7例,163~354天),两组发病时间差异有统计学意义(P=0.010),临床症状以咳嗽(13例)及呼吸困难(17例)多见;激素治疗后16例患者好转,4例进展,4例无变化;高分辨CT显示21例(87.5%)CIP发生在下叶,影像学征象以磨玻璃影(20例,83.3%)及实变影(16例,66.7%)多见,影像学表现模式以机化性肺炎模式(16例,66.7%)为主。结论存在基础肺气肿和间质肺疾病患者CIP发生率高,LC组CIP发生时间早于非LC,影像学表现以磨玻璃影及实变影多见,多发生在下叶,影像学表现模式以机化性肺炎模式为主。

Objective To summarize and analyze the clinical and imaging characteristics of immune checkpoint inhibitor pneumonitis(CIP).Methods The clinical data and a series of chest CT images of 145 patients with advanced malignant tumors treated with immune checkpoint inhibitors were analyzed retrospectively.The incidence,related risk factors,occurrence time,symptoms,imaging characteristics,CIP grade and outcome were analyzed.Results Among 145 patients with advanced malignant tumors,24(16.6%)had CIP.The incidence of CIP was high in patients with basic emphysema and interstitial lung disease,and the differences were statistically significant(all P<0.05).The median time of CIP was 161 days(61~316),including 86 days(17 cases,39~214 days)in lung cancer(LC)group and 256 days(7 cases,163~354 days)in non-LC group.The difference between the two groups was statistically significant(P=0.010).The clinical symptoms were cough(13 cases)and dyspnea(17 cases).After hormone treatment,16 cases improved,4 cases progressed and 4 cases remained unchanged.High-resolution CT showed that 21 cases(87.5%)of CIP occurred in the lower lobe.The imaging signs were more common with ground-glass opacity(20 cases,83.3%)and consolidation shadow(16 cases,66.7%),and the imaging pattern was OP-like(16 cases,66.7%).Conclusion The incidence of CIP is high in patients with basic emphysema and interstitial lung disease.The occurrence time of CIP in LC group is earlier than that in non-LC group.The imaging manifestations are more common with ground-glass opacity and consolidation shadow,mostly in the lower lobe.The imaging manifestation pattern is mainly OP-like.