临床特征和PD-1/PD-L1抑制剂诱导的垂体功能障碍与其他垂体疾病的比较分析
Yan Xiao1, Deyue Jiang1, Shengjie Wang1
1Department of Endocrinology, The First Medical Center, Chinese PLA General Hospital, Beijing, 100853, China.
Scientific reports
|July 2, 2025
概括
编程细胞死亡蛋白-1 (PD-1) 或编程细胞死亡配体-1 (PD-L1) 抑制剂可以导致垂体损伤. 这些与免疫相关的不良事件与异常分离的ACTH缺乏症有共同的症状,但与淋巴细胞性低细胞性炎不同.
科学领域:
- 免疫学 免疫学 免疫学
- 内分泌学 在内分泌学.
- 在瘤学瘤学.
背景情况:
- 免疫检查点抑制剂 (ICI),包括PD-1和PD-L1抑制剂,在癌症治疗中至关重要.
- 垂体损伤是一种已知的与ICI相关的免疫相关不良事件 (irAE).
- 了解ICI诱导的垂体损伤的特定临床特征对于及时诊断和管理至关重要.
研究的目的:
- 研究由PD-1或PD-L1抑制剂 (垂体-irAE) 诱导的垂体损伤的临床特征.
- 为了比较垂体-irAE的临床表现与其他垂体疾病,特别是异常异常隔离ACTH缺乏症 (IIAD) 和淋巴细胞低血症 (LYH).
主要方法:
- 从2015年1月到2024年6月的临床记录的回顾性审查.
- 纳入标准:被诊断患有 pituitary-irAE,IIAD或LYH的患者.
- 对人口统计数据,临床症状,诊断结果和治疗结果的分析.
主要成果:
- 在接受PD-1/PD-L1抑制剂治疗的患者中,0.596%的患者发生了下垂体-irAE.
- 发病的平均年龄为59.4岁,59.09%是男性.
- pituitary-irAE (疲劳,食欲丧失) 的临床症状与 IIAD 相似,与 LYH (多滴psia/多尿症,月经障碍) 不同.
- 所有患有垂体irAE的患者都患有中枢上腺功能不充分; 52.63%的人患有正常的垂体MRI.
- 在激素替代疗法后,在一些患者中观察到部分或完全的垂体功能恢复.
结论:
- pituitary-irAE 的临床表现与 IIAD 类似,但与 LYH 不同.
- 早期识别这些独特的临床模式对于适当的患者管理至关重要.
- 由ICI引起的垂体损伤需要仔细监测和管理,具有功能恢复的潜力.
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