高分辨率CT评估免疫治疗相关性肺炎患者诊疗效果及预后研究

High resolution CT evaluation of diagnosis, treatment, and prognosis in patients with immunotherapy associated pneumonia

摘要:

目的 探讨高分辨率CT评估免疫治疗相关性肺炎患者诊疗效果及预后。方法 2021年5月至2023年5月于肇庆市第一人民医院进行免疫治疗的恶性肿瘤患者1 205例，其中32例治疗后并发免疫相关性肺炎，将所有患者的临床资料进行回顾性分析，对所有患者进行高分辨率计算机断层扫描（CT），分析患者免疫检查点抑制剂治疗情况，免疫相关性肺炎患者临床症状及影像学表现，免疫相关性肺炎出现的时间、诊疗效果及预后。结果 14例非小细胞肺癌患者及6例肺部低分化肉瘤样癌均采用纳武力尤单抗注射液静脉滴注治疗，用药剂量为3 mg/kg，治疗频次为每半个月1次；12例非小细胞肺癌患者采用信迪利单抗静脉滴注治疗，剂量为200 mg/次，频次为每21 d 1次。32例免疫相关性肺炎患者的临床分级情况为：2级3例，3级20例，4级9例。12例为对称分布，而20例为非对称分布。患者分型情况如下：20例为磨玻璃型，6例为实变型，6例为网格型。其中有23例伴有胸膜变厚，23例纵隔淋巴结受累，12例伴有支气管扩张，9例伴有小叶间隔变厚，9例伴有多发小叶中心结节，3例伴有胸腔积液。出现免疫相关性肺炎后，32例患者均停止PD-1抑制剂治疗，而应用糖皮质激素连续治疗1~6周，13例出院。结论 采用高分辨率CT可以对免疫性肺炎进行诊断，并且有助于对患者进行准确分级、分型，对于已经明确诊断的免疫相关性肺炎患者，应立即停止PD-1抑制剂治疗，之后采用糖皮质激素对患者进行治疗，必要时还可联合抗生素治疗。

关键词:高分辨率计算机断层扫描;免疫治疗;相关性肺炎;评估;预后

Abstract:

Objective To explore the diagnostic and therapeutic effects and prognosis of immunotherapy associated pneumonia patients evaluated by high-resolution CT.Methods A total of 1205 malignant tumor patients who underwent immunotherapy in the First People's Hospital of Zhaoqing from May 2021 to May 2023 were delected, of which 32 developed immune related pneumonia after treatment. The clinical data of all patients were retrospectively analyzed, and high-resolution computed tomography (CT) was performed on all patients to analyze the treatment status of immune checkpoint inhibitors, clinical symptoms and influencing factors of immune related pneumonia patients, the occurrence time, diagnosis and treatment effect, and prognosis of immune related pneumonia.Results Fourteen patients with non-small cell lung cancer and 6 patients with poorly differentiated sarcomatoid lung cancer were all treated with intravenous infusion of Navulizumab injection at a dose of 3 mg/kg, with a treatment frequency of once every half month; 12 patients with non-small cell lung cancer were treated with Sintilimab intravenous drip, the dose was 200 mg/time, and the frequency was once every 21 days. The clinical grading of 32 patients with immune related pneumonia is as follows: 3 cases at level 2, 20 cases at level 3, and 9 cases at level 4. Twelve cases showed symmetrical distribution, while 20 cases showed asymmetric distribution. The patient classification is as follows: 20 cases were ground glass type, 6 cases were consolidation type, 6 cases were grid type. There were 23 cases with pleural thickening, 23 cases with mediastinal lymph node involvement, 12 cases with bronchiectasis, 9 cases with thickened interlobular septum, 9 cases with multiple centrilobular nodules, and 3 cases with pleural effusion. After the occurrence of immune related pneumonia, all 32 patients stopped PD-1 inhibitor treatment and received continuous treatment with glucocorticoids for 1 to 6 weeks, and 13 patients were discharged.Conclusion The use of high-resolution CT can diagnose immune pneumonia and help to accurately grade and classify patients. For patients with immune related pneumonia who have already been diagnosed, PD-1 inhibitor treatment should be stopped immediately, followed by treatment with glucocorticoids and, if necessary, combined with antibiotics.

Key words:high-resolution computed tomography;immunotherapy;associated pneumonia;evaluation;prognosis