靶向联合免疫治疗引发肾脏血栓性微血管病1例

Renal thrombotic microangiopathy induced by targeted therapy combined with immunotherapy:a case report

靶向及免疫治疗药物在治疗多种实体及非实体肿瘤中获得了较大的成功,但与药物相关的不良事件发生率较高。该文报告1例因应用靶向联合免疫治疗药物引发的肾脏血栓性微血管病病例。患者原发病为肝内胆管细胞癌,靶向联合免疫治疗期间,肿瘤负荷减轻但出现蛋白尿、水肿和高血压,血管性血友病因子裂解酶活性及其抑制物正常,抗磷脂抗体阳性。肾活检组织病理诊断为肾小球血栓性微血管病伴免疫复合物沉积。经停用抗肿瘤药,予“虫草制剂、α-酮酸片”护肾、升血小板、抗凝等治疗,患者血压降至正常,肾功能稳定,尿蛋白降至弱阳性。

Targeted therapy and immunotherapy have achieved great success in treating various solid and non-solid tumors,but the incidence of drugs-related adverse events is relatively high.The paper reports a case of renal thrombotic microangiopathy in an intrahepatic cholangiocarcinoma patient who underwent targeted therapy combined with immunotherapy.During the treatment,the tumor burden relieved continuously,but the patient developed proteinuria,edema and hypertension.The ADAMTS13 activity and inhibitors were normal,while the antiphospholipid antibody was positive.The patient was finally diagnosed as glomerular thrombotic microangiopathy with immune complex deposition by renal biopsy.After the cease of the antineoplastic agents and treatment with"cordyceps preparations"and"α-keto acids",the patient's blood pressure dropped to normal,her urine protein turnned to weakly positive,and her renal function remained stable.