摘要
目的分析免疫检测点抑制剂(immune-checkpoint inhibitors,ICI)相关肝脏毒性(IMH)患者的临床特点、治疗、转归情况。方法纳入2019年9月至2022年9月上海瑞金医院诊断的14例IMH患者,研究IMH患者起病特点、临床表现、治疗反应及预后转归特点。结果14例IMH患者以男性为主(12例),中位年龄61岁。以黄疸、乏力、尿色黄染为主要症状,临床类型以胆汁淤积型为主(8例),10例患者出现3-4级肝损伤。以保肝药物为基础治疗,有4例患者仅应用糖皮质激素治疗,6例患者联合吗替麦考酚酯治疗。治疗后,5例死亡或自动离院(去除2例因突发其他疾病死亡的患者),7例病情改善。5例预后不良患者的中性粒细胞计数/淋巴细胞计数(NLR)为13.5,7例预后改善患者的NLR为3.3,差异有统计学意义(P<0.05)。结论IMH患者肝功能损伤以胆汁淤积型为主,部分患者治疗后可好转,预后较差。NLR有可能作为评估IMH预后的临床标志物。
Objective To analyze the clinical characteristics,treatment,and prognosis of the patients with ICI-induced immune-mediated hepatotoxicity(IMH).Methods A total 14 IMH patients were retrospectively recruited from Department of Infectious Diseases,Ruijin Hospital between September 2019 to September 2022.The characteristics of onset,clinical manifestations,treatment response and the prognosis of IMH patients were summarized and analyzed.Results The 14 patients(median age,61 years)were mainly males,usually present with jaundice,malaise,and yellow color urine as the main symptoms.The mainly clinical pattern was cholestasis type in 8/12(66.67%),and 10 patients had grade 3-4 liver injury.The patients were treated with diammonium glycyrrhetate or UDCA basically,and 10 patients were treated with steroids(4/10)or steroids combined with second line immunosuppressive treatment(Mycophenolate Mofetil,6/10).After treatment,5 of the 14 patients died or withdrawing treatment due to deterioration of the disease(excluding sudden unexpected death in 2 patients due to other diseases),and 7 patients recovered from IMH.The neutrophil-to-lymphocyte ratio(NLR)in the poor prognosis group was significantly higher than those in the good prognosis group(13.5 vs 3.3,P<0.05).Conclusion Cholestatic type is the main clinical pattern of IMH.Half of the patients recovered after the treatment.The overall prognosis is poor.NLR may be used as a clinical marker to evaluate the prognosis of IMH.
作者
杨思恒
殷荣坤
陈榕
赵钢德
汤伟亮
王伟静
谢青
莫瑞东
YANG Si-heng;YIN Rong-kun;CHEN Rong;ZHAO Gang-de;TANG Wei-liang;WANG Wei-jing;XIE Qing;MO Rui-dong(Department of Infectious Diseases,Ruijin Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200025,China;Department of Infectious Diseases,Jieshou People’s Hospital,Anhui 236500,China;Department of Infectious Diseases,Tongren Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200336,China)
出处
《肝脏》
2024年第1期34-36,共3页
Chinese Hepatology
基金
上海市临床重点专科(感染病学)(shslczdzk01103)
国家自然科学基金(81900527,82070604,82270618)
十三五“科技部重大专项”(2017ZX10203201-008,2018ZX09201016-003-001,2017ZX10202202-005-004)。
作者简介
通信作者:莫瑞东,Email:moruidong626@126.com。
