在持续免疫检查点抑制剂诱导的肝损伤中,生化和组织学严重程度之间的不一致性
Chloe Attree1,2,3, Samuel D Saibil4, Sandra Fischer5
1Hepatology, Sir Charles Gairdner Hospital, Nedlands, Western Australia, Australia chloe.attree@health.wa.gov.au.
BMJ case reports
|August 19, 2025
概括
免疫检查点抑制剂诱导的肝损伤 (ChILI) 尽管接受了治疗,但可能会出现持续的肝酶异常. 这一案例凸显了肝活检在诊断慢性CHILI时的重要性,即使酶没有完全正常化.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 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) 如尼沃卢马布和伊皮利穆马布在癌症治疗中至关重要.
- 免疫检查点抑制剂诱导的肝损伤 (ChILI) 是已知的副作用.
- 慢性CHILI很罕见,对其长期表现和管理的了解有限.
研究的目的:
- 报告一种慢性免疫检查点抑制剂诱导性肝损伤 (ChILI) 的独特病例.
- 为了突出智利肝酶与肝细胞病理学之间的潜在不一致性.
- 讨论慢性CHILI的管理影响.
主要方法:
- 一个病例报告,一名患有转移性黑色素瘤的患者接受了尼沃卢马布和伊皮利穆马布的治疗.
- 通过肝活检对肝酶的监测和组织病理学评估.
- 用免疫抑制剂治疗,包括mycophenolate和prednisone.
主要成果:
- 患者出现了2级CILI,最初情况有所改善,但肝酶的正常化不完全.
- 肝脏活检显示严重的肝炎与接口和周周炎性死炎活动.
- 免疫抑制的上升标配,随后逐渐撤销导致肝酶正常化,没有复发.
结论:
- 在智利,肝酶水平和病理学发现之间可能存在差异.
- 肝活检对于诊断和治疗慢性CHILI至关重要,特别是当酶水平与临床表现不一致时.
- 该病例是首次报告的慢性CILI病例,强调需要对其长期特征和管理策略进行进一步研究.
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