[与免疫检查点抑制剂相关的肺炎:差异性诊断策略]
Anne Bettina Beeskow1, Rebecca Mura2, Daria Kifjak2
1Klinik und Poliklinik für Diagnostische und Interventionelle Radiologie, Universitätsklinikum Leipzig, Leipzig, Deutschland. anne.beeskow@medizin.uni-leipzig.de.
Radiologie (Heidelberg, Germany)
|February 10, 2026
概括
免疫检查点抑制剂相关肺炎 (ICI-P) 呈现非特异性症状. 高分辨率CT (HRCT) 图案有助于诊断,在治疗中断或使用葡萄皮质皮质激素后,变化通常会消失.
科学领域:
- 肺部病理学 肺部病理学
- 在瘤学瘤学.
- 放射学 放射学是一门学科.
背景情况:
- 免疫检查点抑制剂 (ICI) 在癌症治疗中使用.
- 免疫检查点抑制剂相关肺炎 (ICI-P) 是一种严重的并发症.
- ICI-P呈现出不特定的症状,如呼吸障碍和咳,使得CT诊断具有挑战性.
研究的目的:
- 描述ICI-P的临床表现和CT成像模式.
- 为了区分ICI-P与其他肺部疾病,如感染和淋巴炎性癌症.
- 为ICI-P的诊断和管理提供指导.
主要方法:
- 非对比的高分辨率薄截面CT (HRCT) 是主要的成像模式.
- 常见的HRCT模式包括地面玻璃不透明,组织性肺炎 (OP),非特异性间歇性肺炎 (NSIP),支气管中心间歇性肺炎 (BIP) 和扩散性气膜损伤 (DAD).
- 诊断依赖于临床相关性,实验室发现,并排除感染,可能与支气管支气管洗 (BAL).
主要成果:
- 弗莱什纳学会的分类有助于分类异构的CT发现.
- 区分ICI-P与感染和淋巴炎性癌症至关重要.
- CT变化可能会缓慢消失,可能导致慢性ICI肺炎或爆发.
结论:
- 接受ICI治疗的患者的新肺部变化需要考虑时间关联 (ICI开始后的几周到几个月).
- 典型的HRCT模式和风险因素是重要的诊断考虑因素.
- 肺部变化通常会随着ICI治疗中断和/或葡萄糖皮质激素的使用而回归.
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