恶性肿瘤患者免疫检查点抑制剂导致肝损伤的临床处理2例

免疫检查点抑制剂（immune checkpoint inhibitors，ICIs）作为一种新的抗肿瘤药物，目前在临床的使用日益广泛。然而，ICIs过度激活的免疫系统会攻击人体正常器官，引起相关的免疫不良反应，这种免疫损伤可以累及身体的各个部位，引起相应的症状，被称之为ICIs相关不良反应（immunocheckpoint inhibitors related adverse effects，irAEs）。肝损伤作为irAEs其中一种，临床治疗是以糖皮质激素为主，但是对于≥3级以上肝损伤的治疗以及出现激素耐药后的解救治疗仍会让临床医生感到棘手。本研究分析2例经免疫治疗后出现肝损伤的案例，包括激素敏感型1例，激素耐药型1例，后经免疫球蛋白解救治疗成功。 

Clinical management of liver injury caused by immune checkpoint inhibitors in two patients with malignant tumor

Immune checkpoint inhibitors (ICIs) constitute a new class of anti-tumor drugs widely used in clinical practice. However, immune toxicity occurs when ICI-induced activation of the immune system leads to damage of the normal organs of the human body. This type of immune damage can affect any part of the body and can cause symptoms known as immunocheckpoint inhibitors related adverse effects (irAEs). Glucocorticoid is the mainstay of treatment for liver injury. However, ways of managing grade ≥3 liver injury and preventing the development of hormone resistance remain unclear. We described two cases of liver injury after immunotherapy: one patient was corticosteroid-sensitive, while the other was corticosteroid-resistant and received salvage treatment with immunoglobulin.