免疫检查点抑制剂相关性炎治疗标准
Elena-Bianca Barbir1, Abhijat Kitchlu2, Sandra M Herrmann1
1Department of Internal Medicine, Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
概括
免疫检查点抑制剂 (ICI) 治疗越来越多地使用,但可能导致急性损伤 (AKI). 早期诊断和治疗,包括皮质类固醇,往往导致康复,但有些病例需要进一步的干预.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
背景情况:
- 免疫检查点抑制剂 (ICI) 疗法彻底改变了癌症治疗,导致使用量增加和免疫相关不良事件 (irAEs) 的增加.
- 性irrAEs,特别是ICI相关的急性损伤 (ICI-AKI),影响2%-5%的患者,急性管间性炎 (ATIN) 是最常见的病理.
- ICI-AKI的危险因素包括同时使用某些药物和双重ICI治疗 (CTLA-4和PD1/PDL-1阻塞).
研究的目的:
- 审查目前对ICI-AKI病理生理学,诊断和管理的理解.
- 突出新兴的诊断工具和预后因素.
- 在ICI-AKI中确定未来研究领域.
主要方法:
- 对ICI-AKI现有文献的审查.
- 专注于诊断方式,包括脏活检和新生物标志物.
- 对治疗策略和结果的分析.
主要成果:
- 急性管间炎 (ATIN) 是ICI-AKI的最常见原因,尽管还会发生状炎.
- 脏活检是诊断的黄金标准,但正在开发非侵入性生物标志物.
- 第一线治疗包括保持ICI,停止相关药物,并启动皮质类固醇,往往导致恢复.
结论:
- 及时诊断和治疗ICI-AKI对于脏恢复和潜在的ICI重新挑战至关重要.
- 皮质类固醇耐药或依赖性病例可能需要使用类固醇节约剂.
- 需要进一步的前性研究来完善ICI-AKI的诊断,管理和预后.
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