摘要
免疫检查点抑制剂(Immune checkpoint inhibitors,ICIs)在临床应用中日益广泛,有关其新的或罕见的免疫相关不良事件(Immune-related adverse events,irAEs)的报告也逐渐增多,故应及早认识、确诊和治疗irAEs,以减少其给患者带来的危害。本文报道1例男性患者,73岁,诊断为食管胸下段恶性肿瘤(鳞癌,rT1N1M0,IIB期),在行“紫杉醇(白蛋白结合型)+卡铂+信迪利单抗”2个疗程后,出现尿频、尿急、尿痛、血尿等尿路刺激症状,并伴腰背部及下腹部疼痛,尿常规示白细胞和红细胞增多,泌尿系彩超和CT示右侧输尿管扩张,膀胱壁增厚,膀胱镜检查示出血性膀胱炎,考虑信迪利单抗所致免疫性膀胱炎,给予患者注射用甲泼尼龙琥珀酸钠(80 mg/d,ivgtt)治疗,后逐步缓慢减量至口服甲泼尼龙,患者尿路刺激症状缓解,疼痛缓解,治疗有效。本文通过对该病例的讨论与分析,为ICIs致免疫性膀胱炎患者的个体化药物治疗提供参考。
Immune checkpoint inhibitors(ICIs)have been increasingly used in clinical practice,and reports on novel or rare immune-related adverse events(irAEs)are also on the rise.Therefore,it is crucial to recognize,diagnose,and treat irAEs promptly to minimize their harm to patients.A 73-year-old male patient diagnosed with a malignant tumor in the lower thoracic segment of the esophagus(squamous cell carcinoma,rT1N1M0,stage IIB)experienced urinary irritation symptoms of urinary frequency,urinary urgency,urinary pain,and hematuria after two cycles of treatment with"paclitaxel(albumin-bound)+carboplatin+sintilimab".He also suffered from back and lower abdominal pain.Urinalysis showed that the white blood cell count and red blood cell count were increased,ultrasonography and CT scan revealed dilation of the right ureter and thickening of the bladder wall,and cystoscopy indicated hemorrhagic cystitis,which was considered to be immune cystitis caused by sintilimab.The patient was treated with intravenous injections of methylprednisolone sodium succinate(80 mg/d,ivgtt),which were gradually tapered off to oral methylprednisolone.The patient's urinary irritation symptoms and pain were relieved,indicating that the treatment was effective.This article provides references for individualized drug treatment of patients with ICIs-induced immune cystitis.
作者
汪国玉
姜伟
张梅
黄光耀
王君萍
Wang Guoyu;Jiang Wei;Zhang Mei;Huang Guangyao;Wang Junping(Center of Pharmacy,Hefei Cancer Hospital,Chinese Academy of Sciences,Hefei 230031,China)
出处
《实用药物与临床》
2025年第2期136-140,共5页
Practical Pharmacy and Clinical Remedies
基金
安徽省卫生健康委科研项目齐鲁肿瘤专项(AHWJ2023BAa20074)。
