一个患有自身免疫倾向的患者因免疫检查点抑制剂引起的1型糖尿病病例
Miyu Tomiki1, Keiichiro Matoba1, Kensuke Sekiguchi1
1Division of Diabetes, Metabolism and Endocrinology, Department of Internal Medicine, The Jikei University School of Medicine, Japan.
一名73岁的妇女在接受尼沃卢马布和伊皮利穆马布治疗黑色素瘤后患上1型糖尿病. 这突显了与免疫相关的不良事件的风险,特别是在自身免疫倾向的患者中.
科学领域:
- 免疫学
- 内分泌学
- 癌症学
背景情况:
- 免疫检查点抑制剂 (ICI) 如nivolumab和ipilimumab用于治疗黑色素瘤.
- 可引起免疫相关的不良事件 (irAEs),包括内分泌功能障碍.
- 患有自身免疫性疾病的患者可能面临更高的IRA风险.
研究的目的:
- 在接受ICI治疗的患者中报告爆发型1型糖尿病病例.
- 研究ICI在导致自身免疫性糖尿病的潜在作用.
- 强调对敏感患者内分泌IRAE的监测的重要性.
主要方法:
- 一个73岁的女性患有恶性黑色素瘤的病例报告.
- 用尼沃卢马布和伊皮利穆马布治疗
- 临床和实验室评估高血糖,酸性和自身免疫标志物.
主要成果:
- 患者出现严重的高血糖 (596 mg/ dL) 和酸症.
- 反GAD抗体呈阳性,表明自身免疫性糖尿病.
- 尽管具有保护性HLA单元型,但发生了 fulminant型1型糖尿病.
- 格雷夫斯病史和家族自身免疫性表明有这种倾向.
结论:
- 免疫检查点抑制剂甚至可以在具有保护性HLA基因型的患者中引发发性1型糖尿病.
- 潜在的自身免疫性倾向, 根据Graves病和家族病史, 可能会被ICI加剧.
- 在接受ICI治疗的患者,特别是自身免疫背景患者中,对内分泌IRA的密切监测至关重要.
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