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摘要：
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摘要：目的 探讨程序性死亡受体-1（programmed death-1，PD-1）抑制剂介导肝损伤患
者的临床特征、肝脏组织学特点、诊疗方法及预后。方法 回顾性收集2016年4月1日至
2024年10月31日于首都医科大学附属北京友谊医院住院应用免疫检查点抑制剂（immune
checkpoint inhibitors，ICIs）治疗并行肝穿刺活检的恶性肿瘤患者的临床资料，分析其临
床表现、实验室结果、影像学表现、肝脏病理特征、治疗及随访结果。结果 共纳入6例
患者，所有患者应用ICIs类型均为PD-1抑制剂，出现肝损伤时应用的ICIs周期中位数为
3.5。6例患者的临床症状无特异性，均出现了黄疸；3例患者腹部影像学无肝胆系统异
常表现；5例患者的肝损伤类型为胆汁淤积型；所有患者的RUCAM评分均在7分以上，
CTCAE分级均在3级以上。6例患者的肝组织病理特点为总体炎症较轻，主要表现为小
叶内或汇管区炎症，伴淋巴细胞、中性粒细胞等炎细胞浸润，均有不同程度的胆管损伤
表现。4例患者应用激素治疗，2例患者未用激素治疗，所有患者肝脏生物化学指标均好
转或复常。结论 PD-1抑制剂介导肝损伤患者的临床症状及影像学表现无特异性，肝组
织总体炎症较轻，以小叶内或汇管区炎症为主，可伴有胆管损伤。PD-1抑制剂介导肝损
伤类型多为胆汁淤积型，激素治疗有效但肝脏生物化学指标恢复较慢。
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Abstract: Objective To investigate the clinical characteristics, histological features of liver
tissue, diagnostic and therapeutic methods, and prognosis in patients with liver injury mediated
by programmed death-1 (PD-1) inhibitors. Methods Clinical data of patients with malignant
tumors who were admitted to Beijing Friendship Hospital, Capital Medical University and
treated with immune checkpoint inhibitors (ICIs) with liver biopsy from April 1st, 2016
to October 31st, 2024 were retrospectively collected. The clinical manifestations, imaging
findings, pathological features of liver, treatments and follow-up results were analyzed.
Results A total of 6 patients were included. All patients were treated with PD-1 inhibitors.
The median ICI cycle was 3.5. The clinical symptoms of the 6 patients were nonspecific,
with all patients presenting jaundice. Three patients had no abnormalities in the hepatobiliary
system on abdominal imaging. Five patients had cholestatic liver injury. All patients had a
RUCAM score of 7 or higher and a CTCAE grade of 3 or higher. The histological features
of liver in the 6 patients were characterized by mild overall inflammation, mainly manifested
as inflammation within the lobules or portal areas, with lymphocyte, neutrophil, and other
inflammatory cell infiltration, and all had varying degrees of biliary tract injury. Four patients
were treated with corticosteroids, and 2 patients were not treated with corticosteroids. The
liver function indicators of all patients improved or normalized. Conclusions Clinical symptoms
and imaging findings in patients with liver injury mediated by PD-1 inhibitors were nonspecific.
The overall inflammation in liver tissue was relatively mild, mainly characterized by inflammation
within the lobules or portal areas, and might be accompanied by biliary tract injury. The type of
liver injury mediated by PD-1 inhibitors was mostly cholestatic. Corticosteroid treatment was
effective, but the recovery of liver biochemical indicators was relatively slow.
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