粒细胞或粒细胞-巨噬细胞集落刺激因子致肺毒性临床特征分析

Clinical features of pulmonary toxicity induced by granulocytes or granulocyte-macrophage colony-stimulating factors

目的探讨粒细胞或粒细胞-巨噬细胞集落刺激因子(G-CSF或GM-CSF)致肺毒性的临床特点。方法检索中国知网、万方、维普、PubMed、Embase数据库自建库至2022年8月31日期间发表的关于G-CSF或GM-CSF致肺毒性的病例报道,对其进行回顾性分析。结果共纳入34例患者,中位年龄为59岁(3~82岁);肺部症状多在G-CSF或GM-CSF给药后第5日出现,主要表现为呼吸困难(64.7%)、发热(47.1%)、咳嗽(20.6%);影像学特征以双侧肺渗出(82.1%)和肺间质性损伤(50.0%)为主。在停用G-CSF或GM-CSF并接受治疗干预(包括糖皮质激素和吸氧治疗)后,25例(73.5%)患者症状改善。结论肺毒性是G-CSF或GM-CSF罕见的不良反应,早期诊断、及时停药和治疗干预对预后有重要意义。G-CSF或GM-CSF治疗期间应加强呼吸困难、咳嗽和发烧等症状的监测,警惕G-CSF或GM-CSF导致肺毒性的发生。

Objective To determine the clinical features of pulmonary toxicity induced by granulocyte-(macrophage)colony-stimulating factors(G-CSF or GM-CSF).Methods We collected and analyzed case reports from the inception to August 31st,2022 in CNKI,Wanfang,VIP,PubMed and Embase databases on pulmonary toxicity induced by G-CSF or GM-CSF retrospectively.Results Totally 34 patients were included.The median age of patients was 59 years(3~82).The median time of onset of clinical symptoms was 5 days after G-CSF or GM-CSF administration.Common initial symptoms included dyspnea(64.7%),fever(47.1%),and cough(20.6%).The main radiological features were characterized by exudation(82.1%)and interstitial lung damage(50.0%)in bilateral lungs.After the discontinuation of G-CSF or GM-CSF and starting the therapeutic interventions(including glucocorticoids and oxygen therapy),25 patients(73.5%)recovered.Conclusion Pulmonary toxicity is a reversible reaction of G-CSF or GM-CSF.Earlier diagnosis,cessation of G-CSF or GM-CSF and therapeutic interventions are important for prognosis.Attention should be paid to possible pulmonary toxicity in patients with symptoms such as dyspnea,cough,and fever during G-CSF or GM-CSF treatment.