区分班达诱导的肝损伤与免疫治疗的肝炎 - - 结构化因果关系评估的重要性:一个案例报告
Arunkumar Krishnan1,2, Kaleb Lucas3, Laura Maas4
1Department of Supportive Oncology, Atrium Health Levine Cancer, Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Charlotte, NC 28204, United States.
World journal of clinical cases
|January 29, 2026
概括
治疗癌症的自给药芬班达,通常在网上推广,可导致免疫治疗患者严重肝损伤. 及时诊断和停止使用芬班达对于恢复和继续癌症治疗至关重要.
科学领域:
- 肝病学 肝病学是一种肝病学.
- 在瘤学瘤学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 药物诱导性肝损伤 (DILI) 在瘤学中存在诊断挑战,特别是在免疫检查点抑制剂 (ICI) 中,因为与免疫媒介性肝炎的症状重叠.
- 社交媒体的趋势鼓励人们自行服用兽医药物,比如用于治疗癌症的班达,通常是高剂量,没有医疗监督,这引发了安全问题.
研究的目的:
- 在接受免疫治疗的患者中报告与自给药芬本达相关的严重肝细胞损伤病例.
- 突出区分DILI与癌症患者的免疫相关不良事件 (irAEs) 的重要性.
主要方法:
- 一个47岁妇女患有转移性结肠癌的病例报告,接受了尼沃卢马布/雷拉特利马布治疗.
- 详细的病史和时间分析,包括使用罗塞尔·乌克拉夫因果关系评估方法 (RUCAM) 评分进行因果关系评估.
- 在停止使用班达和重新开始免疫治疗后,监测肝脏生物化学和临床反应.
主要成果:
- 患者在增加自给药的班达剂量后发生严重的肝细胞损伤.
- 班达被确定为可能的原因 (RUCAM分数8).
- 芬班达取消后,生物化学标记物迅速改善;免疫治疗安全地重新开始,肝损伤没有复发.
结论:
- 彻底的药物史和因果关系评估对于在癌症患者中区分DILI和irAEs至关重要.
- 对于在社交媒体上宣传的未经证实的治疗方法的风险,对患者进行咨询至关重要.
- 准确的诊断可以防止不必要的治疗修改和延迟癌症治疗.
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