PD-1/PD-L1抑制剂致免疫检查点抑制剂相关性肺炎的临床特点分析

Analysis of clinical characteristics of immune checkpoint inhibitor-related pneumonitis induced by PD-1/PD-L1 inhibitor

目的探讨PD-1/PD-L1抑制剂致免疫检查点抑制剂相关性肺炎(CIP)的临床特点。方法回顾性选取2020年1月1日至2022年12月31日河北省人民医院住院接受PD-1/PD-L1抑制剂治疗的恶性肿瘤患者,筛选出根据诺氏评估量表判定为“很可能”或“肯定”发生CIP的患者,分析CIP患者的临床特点。结果共960例患者接受PD-1/PD-L1抑制剂治疗,有17例(1.77%)患者发生CIP,男女比例为14∶3,平均年龄为(64±11)岁,原患疾病以肺癌居多(13例,76.47%)。初次用药至发病的中位时间为4.5个月,其中1例患者CIP发生在末次治疗6个月后。CIP临床表现主要为气短、咳嗽、咳痰和发热等,影像学检查多见斑片状密度增高影和磨玻璃影等。诊断为CIP后,16例患者接受糖皮质激素治疗,1例未接受任何治疗。经停药和对症治疗后,15例好转,1例死亡,1例CIP好转后复发。结论CIP的发生率相对较低,在PD-1/PD-L1抑制剂治疗过程中需加强用药监测,关注患者的临床症状及肺部影像学特征,鉴别其可能导致的CIP,同时需警惕停药数月后的迟发性CIP。

Objective To investigate the clinical characteristics of immune checkpoint inhibitor-related pneumonitis(CIP)induced by PD-1/PD-L1 inhibitor.Methods The subjects were retrospectively selected from all malignant tumor pa⁃tients treated with PD-1/PD-L1 inhibitor during hospitalization in Hebei General Hospital from January 1,2020 to December 31,2022.Patients who were identified as"probable"or"definite"to have developed CIP according to Naranjo′s assessment scale were selected,and the clinical characteristics were analyzed.Results A total of 960 patients were treated with PD-1/PD-L1 inhibitors,and 17 patients(1.77%)developed CIP.The male-to-female ratio was 14∶3 and the average age was(64±11)years old.Lung cancer was the most common primary disease(13 cases,76.47%).The median time from initial medica⁃tion to onset was 4.5 months,with one case occurring 6 months after cessation of immunotherapy.The main clinical manifes⁃tations of CIP were shortness of breath,cough and expectoration and fever.The common radiological features were plaquelike high density shadow,ground glass opacities.After the diagnosis of CIP,16 patients received glucocorticoid therapy and 1 patient received no intervention.After drug withdrawal and symptomatic treatment,15 patients recovered,1 patient died,and 1 patient relapsed after CIP recovery.Conclusion The incidence of CIP is relatively low.It is necessary to strengthen drug monitoring,pay attention to the clinical symptoms and radiological characteristics of lung,and identify the possible CIP during the treatment with PD-1/PD-L1 inhibitor.At the same time,clinicians should be alert to the delayed CIP that may occur sever⁃al months after drug discontinuation.