诊断学理论与实践

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2022 , Vol. 21 >Issue 06: 741 - 745

DOI: https://doi.org/10.16150/j.1671-2870.2022.06.13

病例报告

小细胞肺癌患者采用PD-L1抑制剂治疗致垂体炎1例报道并文献复习

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  • 1.无锡市新吴区新瑞医院呼吸与危重症医学科，江苏 无锡 214000
    2.上海交通大学医学院附属瑞金医院呼吸与危重症医学科，上海 200025
    3.上海交通大学医学院呼吸病研究所，上海 200025

收稿日期: 2022-07-26

  网络出版日期: 2023-04-23

基金资助

无锡市太湖人才计划——高端医学人才项目(RJWX-001)

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PD-L1 inhibitors-induced hypophysitis in a patient with small cell lung cancer: a case report and literatures review

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  • 1. Pulmonary and Critical Care Medicine,Wuxi Xinwu District Xinrui Hospital, Wuxi, Jiangsu 214000
    2. Pulmonary and Critical Care Medicine, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025
    3. Institute of Respiratory Diseases,Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received date: 2022-07-26

  Online published: 2023-04-23

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摘要

本文报道1例经细胞程序性死亡配体1（Programmed cell death-ligand 1，PD-L1）抑制剂治疗7个周期后导致免疫相关垂体炎（immune-related hypophysitis， irH）病例。患者表现为乏力、纳差、低血压，血清促肾上腺皮质激素（adrenocorticotropic hormone，ACTH）、促甲状腺激素水平较PD-L1抑制剂治疗前明显降低（分别由治疗前的正常值48 ng/L、4.64 μIU/mL降至3.8 ng/L、0.266 μIU/mL），予氢化可的松替代治疗20 d后，患者的临床症状及激素水平逐步好转。回顾近10年PubMed、万方及中国知网数据库收录的由免疫检查点抑制剂导致的300余例垂体炎病例，其中84例肺癌患者，由PD-L1抑制剂引起irH的肺癌患者为10例，患者主要表现为乏力、厌食、体重下降、低血压。与细胞毒性T淋巴细胞相关蛋白4抗体阻断剂相比， PD-1/PD-L1引起的irH发病率低，且发病相对较迟，且垂体MRI检查多无明显异常，但病情危重，甚至可危及生命，临床需引起重视。

关键词： 程序性死亡配体抑制剂; 小细胞肺癌; 免疫相关垂体炎

本文引用格式

张美玲, 朱潇邦, 宋爱玲, 周剑平, 李庆云 . 小细胞肺癌患者采用PD-L1抑制剂治疗致垂体炎1例报道并文献复习[J]. 诊断学理论与实践, 2022 , 21(06) : 741 -745 . DOI: 10.16150/j.1671-2870.2022.06.13

Abstract

This paper reports a case of immune-related hypophysitis (irH) after 7 cycles of treatment with Duva-lizumab, a PD-L1 (programmed cell death-ligand 1) inhibitor in a patient with small cell lung cancer. The patient showed fatigue, anorexia, hypotension, with lower serum levels of adrenocorticotropic hormone (ACTH) (3.8 ng/L) and thyroid stimulating hormone（TSH）(0.266 μIU/mL) than those before treatment (48 ng/L, 4.64 μIU/mL). The patient′s condition gradually improved with hydrocortisone replacement treatment. PubMed, Wanfang, and CNKI databases were searched.A total of 316 cases have been reported in recent 10 years, including 10 cases with irH caused by PD-1/PD-L1 in 84 lung cancer patients, mainly manifested as fatigue, anorexia, weight loss, and hypotension. Compared with cytotoxic T lymphocyte associated protein 4 antibody blocker treatment, the incidence of PD-1/PD-L1 induced-irH is low, and onset of irH is later. Pituitary MRI images mostly showed no abnormality. However, the condition of the patients was often critical or even life-threatening, which need to pay attention to.

Key words： Programmed cell death-ligand 1 inhibitor; Small cell lung cancer; Immune-related hypophysitis

参考文献

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