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胃肠异常:一种罕见的与免疫相关的不良事件,需要早期识别和高剂量免疫抑制
Benjamin Norton1,2, Stefan Sennfalt3, Ross Nortley3,4
1Gastroenterology, Digestive Disease and Surgery Institute, Cleveland Clinic London, London, GBR.
胃肠异位症是一种罕见的与免疫相关的不良事件,来自免疫检查点抑制剂. 早期,密集的免疫抑制可以为患有这种严重疾病的患者挽救生命.
科学领域:
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
- 胃肠病学 胃肠病学
背景情况:
- 免疫检查点抑制剂 (ICI) 在癌症治疗中至关重要,但可能导致与免疫相关的不良事件 (IRAE).
- 胃肠道 (GI) 的IRAE是常见的,但GI异常 (例如,伪阻塞,胃) 是非常罕见的.
- 血清阴性肠胃异位症呈现没有特定的自身抗体,使诊断复杂化.
研究的目的:
- 报告一种罕见的血清阴性消化道异位症的病例,该病例是 pembrolizumab 治疗的次要病例.
- 要突出与这个IRAE相关的多系统自主特征.
- 强调在管理严重的胃肠道疾病时需要积极的免疫抑制疗法.
主要方法:
- 一个用 pembrolizumab 治疗的转移性黑色素瘤患者的病例介绍.
- 详细的临床评估,包括排除副瘤病因和自身抗体 (抗Hu,抗nAChR) 血清学测试.
- 治疗方案包括高剂量脉冲甲基普雷迪尼索隆,普雷迪尼索隆缩小剂量,以及基酸维护.
主要成果:
- 患者出现了严重的胃肠道失调 (便秘,早,膨胀) 和自主症状 (视力模糊,口腔干燥,静止性低血压).
- 调查排除了副瘤病因,证实了血清阴性呈现.
- 积极的免疫抑制治疗导致恢复和恢复口服营养.
结论:
- 非典型的消化道IRAE如dysautonomia需要迅速识别和高强度的免疫抑制.
- 当前的指导方针可能无法充分覆盖这种罕见和严重的表现.
- 早期,积极的治疗对于患者的康复和功能生存至关重要.
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