免疫相关性重症肺炎1例

Immune-related severe pneumonia: A case report

免疫治疗是目前抗肿瘤治疗中的热门领域之一,免疫治疗为传统化疗、放疗及靶向治疗效果不佳的患者带来新的希望,其主要通过抑制肿瘤细胞免疫逃逸机制,使患者自身免疫系统对抗肿瘤细胞发挥治疗作用^([1])。目前主要的免疫治疗使用免疫检查点对应的抗体即免疫检查点抑制剂(immunecheckpoint inhibitor, ICI),由于抗肿瘤免疫治疗解除了原有的免疫自稳状态,因此治疗后可能导致一些正常的组织细胞亦受到免疫系统攻击,从而出现免疫相关不良反应(immune-related adverse event,irAE)。

With the continuous development and maturity of anti-tumor immunotherapy technology,immune checkpoint inhibitors as one of the main methods of immunotherapy were increasingly widely used in clinical tumor cases,bringing new hope for many advanced cancer patients with poor response to traditional treatment,but at the same time,reported on adverse reactions of various organs related to this were also increasing,and the immune damage caused by them was harmful to patients,especially immune checkpoint inhibitor-associated pneumonia,immune checkpoint inhibitor-associated myocarditis and immune checkpoint inhibitor-associated encephalitis,which could even seriously endangered the lives of patients.Therefore,it was necessary for clinicians to fully understand and master the mechanism,clinical characteristics,laboratory and imaging examination characteristics,diagnostic criteria and differential diagnosis conditions,and treatment principles of adverse reactions that may be caused by immune checkpoint inhibitors,so as to find a more optimized anti-tumor treatment regimen and actively prepared for the treatment of possible immune-related adverse reactions.In this paper,we reported a case of immune checkpoint inhibitor-associated severe pneumonia,referred to the relevant guidelines,introduced its clinical features,laboratory and imaging findings,difficulties encountered in the diagnosis and treatment process,briefly analyzed the causes,and reviewed the possibility of immune-related pneumonia should be considered when respiratory symptoms occurred in patients receiving immunotherapy;the increased ratio of blood neutrophil count to lymphocyte count,and the increased ratio of eosinophil count to lymphocyte count could be used as indicators to indicate immune-related adverse reactions in patients;bronchoalveolar lavage fluid examination and bronchoscopy and lung biopsy were helpful for the diagnosis;when immune checkpoint inhibitor-associated severe pneumonia occurred,in addition to symptomatic and sup-portive treatment,adequate glucocorticoid-based immunosuppressive therapy should be given in time,and combined with cytokines monoclonal antibodies and other biological agents,immunoglobulin co-therapy,but the current indications for the use of biological agents were not fully clear,and the use of high-dose immunosuppressive drugs might cause the risk of severe infection.Therefore,according to the relevant literature and the findings in the process of clinical diagnosis and treatment,this paper proposed that the serum levels of IL-6,TNF-α,CRP and other inflammatory mediators in patients may be used as a quantitative indication to initiate biological agent therapy and accumulate experience for better solving similar problems in the future.