免疫检查点抑制剂治疗后的胃肠异常:一系列病例和系统审查
S Sennfält1, B Norton2,3, A T Jarjis4
1Department of Neurology, National Hospital for Neurology and Neurosurgery, London, UK.
Neurogastroenterology and motility
|November 30, 2025
概括
免疫检查点抑制剂 (ICI) 治疗可能会导致罕见的胃肠道 (GI) 失调症,这是影响神经系统的严重疾病. 早期识别和免疫抑制对于管理这种可能致命的免疫相关不良事件 (IrAE) 至关重要.
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
- 神经学 神经学
背景情况:
- 免疫检查点抑制剂 (ICI) 已经彻底改变了癌症治疗,但可以诱导与免疫相关的不良事件 (IRAE).
- 胃肠道 (GI) 失自症是一种罕见但严重的IrAE,其结果是肠道神经系统的功能障碍,可能伴有全局自主性衰竭.
- 这项研究通过一系列病例和系统的文献审查来研究ICI治疗后的GI dysautonomia.
研究的目的:
- 描述ICI治疗后经历胃肠道异位症患者的临床特征,治疗策略和结果.
- 系统地审查关于ICI诱导的肠道疾病的现有文献,以确定呈现,管理和死亡率的趋势.
- 强调早期诊断和干预对于这种可能危及生命的疾病的重要性.
主要方法:
- 一个由三名患有ICI诱导的肠道功能障碍症的患者在专门的神经毒性服务中心接受治疗的病例系列.
- 通过使用OVID,Cochrane和Scopus数据库进行了系统的文献搜索,直到2024年12月.
- 该审查侧重于临床表现,治疗选择和与ICI诱导的肠道肠道异位症相关的死亡率.
主要成果:
- 三名男性患者在ICI治疗黑色素瘤或软骨肉瘤后出现严重的肠道功能障碍,包括全肠和自主干扰.
- 两名患者经历了不良结果,包括对营养支持的依赖和胃肠道并发症的死亡; 一名患者对皮质类固醇和酸菌有反应.
- 系统性审查确定了18个病例,平均发病时间为ICI暴露后13.6周. 皮质类固醇在72%的患者中被使用,但通常是低剂量或有限的持续时间. 恢复发生在38.5%,死亡率为47%.
结论:
- 免疫检查点抑制剂诱导的胃肠道失调是一种严重且可能致命的免疫相关不良事件.
- 早期识别和迅速,有效的免疫抑制疗法对于改善患者的治疗结果至关重要.
- 需要进一步的研究来优化这种罕见但毁灭性的疾病的治疗策略.
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