免疫检查点抑制剂导致甲状腺功能异常的中西医诊疗思路

Diagnosis and Treatment Thoughts of Traditional Chinese and Western Medicine for Thyroid Dysfunction Caused by Immune Checkpoint Inhibitor

随着免疫检查点抑制剂(immune checkpoint inhibitor,ICPi)治疗人群的不断扩大,以及临床上的应用,接受这些药物治疗的患者生存时间明显提高,免疫相关不良反应的发生也逐渐受到重视。免疫系统的过度反应会导致不良反应的发生,这些不良反应称为免疫相关不良事件(Immune related adverse events,irAEs)。irAEs可以影响多个器官系统,其中内分泌系统是最常受累的系统之一,而甲状腺功能减退和甲状腺功能亢进的发生率最高,现代医学经常通过适当的激素替代,硫代酰胺,皮质类固醇来治疗,但仍有部分患者未能完全缓解,中医药可展现出其独特的优势和价值,很好的改善这部分患者症状,提高生存质量。本文就中西医诊疗ICPi所致甲状腺irAEs进行综述。

With the continuous expansion of the population treated with immune checkpoint inhibitor(ICPi)and its clinical application,the survival time of patients treated with these drugs has been significantly improved,and the occurrence of immune-related adverse reactions has been paid more and more attention.The overreaction of immune system will lead to the occurrence of adverse reactions which are called immune-related adverse events(irAEs).IrAEs can affect many organ systems,among which endocrine system is one of the most frequently involved systems,and hypothyroidism and hyperthyroidism have the highest incidence.Modern medicine often treats them with appropriate hormone replacement,thioamide,and corticosteroids,but some patients still fail to completely alleviate.Traditional Chinese medicine shows its unique advantages and values,and improves the symptoms and the quality of life of these patients.This paper reviewed the diagnosis and treatment of traditional Chinese and western medicine for thyroid irAEs caused by ICPi.