|
摘要：
|
|
摘要：目的 分析中晚期原发性肝癌患者使用免疫检查点抑制剂（immune checkpoint
inhibitors，ICIs）后出现多个内分泌腺体损伤的临床特征。方法 对2023年1月1日至2024年
11月30日于首都医科大学附属北京地坛医院就诊且使用ICIs后出现2个及2个以上内分泌
腺体功能异常的患者进行回顾性分析，包括临床表现、实验室检查、影像学特征、治
疗及预后。结果 共纳入7例患者，其中男性5例，女性2例，年龄（61.3 ± 9.2）岁。所
有患者均接受了程序性死亡受体（programmed death-1，PD-1）单抗联合酪氨酸激酶抑
制剂（tyrosine kinase inhibitors，TKI）治疗。出现甲状腺功能异常的时间为使用ICIs后
25（7，28.5）周，出现垂体功能损伤的时间为使用ICIs后33（30，48.5）周。主要临床
表现为乏力。所有患者均出现中枢性肾上腺皮质功能减退，4例符合肾上腺危象。甲状
腺功能异常的主要形式是原发性甲状腺功能减退。5例患者先出现甲状腺功能异常，后
出现垂体损伤，其中3例患者肾上腺皮质功能减退症状发生于甲状腺激素替代治疗后。
结论 ICIs可导致多内分泌腺体损伤，主要表现为中枢性肾上腺皮质功能减退甚至肾上腺
危象以及原发性甲状腺功能异常，建议行甲状腺激素替代治疗前先完善下丘脑-垂体-肾
上腺皮质轴功能评估，正确评估并替代治疗有助于提高免疫治疗的安全性。
|
|
Abstract: Objective To investigate the clinical characteristics of multiple endocrine gland
injuries in patients with intermediate to advanced primary hepatocellular carcinoma following
treatment with immune checkpoint inhibitors (ICIs). Methods A retrospective analysis was
conducted on patients treated in Beijing Ditan Hospital, Capital Medical University and
developed dysfunction in two or more endocrine glands after ICIs therapy from January 1st 2023
to November 30th 2024. Clinical manifestations, laboratory tests, imaging features, treatment
and prognosis were evaluated. Results A total of 7 patients were included, including 5 males and
2 females, with an age of (61.3 ± 9.2) years old. All patients received programmed cell death-1
(PD-1) inhibitors combined with tyrosine kinase inhibitors (TKI) therapy. Thyroid dysfunction
occurred at 25 (7, 28.5) weeks post-ICIs initiation, while pituitary dysfunction occurred at
33 (30, 48.5) weeks. The primary clinical manifestation was fatigue. All patients developed
secondary adrenal insufficiency, and 4 cases were consistent with adrenal crisis. The
predominant form of thyroid dysfunction was primary hypothyroidism. Five patients exhibited
thyroid dysfunction prior to pituitary injury, among which three patients experienced adrenal
cortex dysfunction symptoms after thyroid hormone replacement therapy. Conclusions ICIs
could induce multiple endocrine gland injuries, and the primary manifesting were secondary
adrenal insufficiency (including adrenal crisis) and primary thyroid dysfunction. It was
recommended to assess the hypothalamic-pituitary-adrenal axis function before initiating
thyroid hormone replacement therapy. Accurate evaluation and appropriate replacement
therapy were crucial for enhancing the safety of immunotherapy.
|
|
基金项目：
|
|
|
|
作者简介：
|
|
|
|
参考文献：
|
|
|
|
服务与反馈：
|
|
【文章下载】【加入收藏】
|
|
|
|