免疫检查点诱导的结肠炎:一个单一中心的回顾性队列研究
Bengt Van Holder1,2, Julie Vereecke2,3, Nathan Ureel2
1Department of Medical Oncology, Ghent University Hospital, 9000 Ghent, Belgium.
Journal of clinical medicine
|October 29, 2025
概括
免疫检查点抑制剂 (ICI) 大肠炎通常是显微的,即使使用正常内镜. 联合ICI疗法预测类固醇耐药性,这表明早期的生物治疗是有效管理ICI诱导性结肠炎的必要.
科学领域:
- 在瘤学瘤学.
- 胃肠病学 胃肠病学
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI) 彻底改变了癌症治疗,但可以导致与免疫相关的不良事件,特别是结肠炎.
- 由于这些疗法的使用日益增加,了解和管理ICI诱导性结肠炎至关重要.
研究的目的:
- 详细介绍ICI诱导性大肠炎的临床,内镜和组织学特征.
- 评估ICI诱导大肠炎的治疗结果,在现实环境中使用皮质类固醇和生物制剂.
主要方法:
- 一项对77名ICI诱导大肠炎的成年患者进行的回顾性队列研究 (2012-2023年).
- 对临床,生化,内镜,组织学数据和治疗反应/安全结果的分析.
主要成果:
- 微观性结肠炎在88%的患者中发现,内镜检测结果正常.
- 联合ICI治疗与更高的梅奥得分和更大的生物制剂需求相关 (p=0.011).
- 皮质类固醇的临床响应率为79.6%,生物制剂的临床响应率为100%;ICI重新挑战的复发率为17.4%.
结论:
- 随机活检的微观发现在ICI诱导的大肠炎中很常见,即使没有内镜迹象.
- 联合ICI疗法可能表明,由于皮质类固醇耐药性,需要早期升级至生物药物.
- 在可管理的大肠炎发病率的情况下,ICI重新挑战是可行的,尽管需要进行前性研究.
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