免疫检查点抑制剂相关性肺炎的临床观察及文献复习

目的:观察免疫检查点抑制剂相关性肺炎（checkpoint inhibitor pneumonitis,CIP）的发生率、症状及影像学表现，并探索其危险因素。方法:回顾性分析2018年03月至2020年12月在青岛市市立医院接受免疫治疗的60例患者的临床资料，总结CIP的发生率，观察其临床症状和影像学征象，并对CIP患病组和未患病组的临床资料进行统计学分析，探索影响CIP发生的危险因素。结果:60例患者中，5例发生CIP（3例G1，1例G2，1例G4），发生率8.3%，1例死亡，死亡率1.7%。CIP发生中位时间2.1个月（2~9个月）。临床症状主要包括呼吸困难、咳嗽、发热和胸痛。影像学表现各异，共同点是多个病例出现磨玻璃密度影、小叶间隔增厚，分布区域位于支气管血管束周围或胸膜下区。 合并肺部基础疾病可能为CIP发生的危险因素。结论:免疫检查点抑制剂相关性肺炎发生率较低，临床症状及影像学征象无特异性，无明确诊断标准。目前临床诊治经验少，严重者可危及生命，早发现、早诊断、早干预至关重要。

Clinical observation and literature review of checkpoint inhibitor pneumonitis

Objective:To clarify the incidence,symptoms and imaging findings of checkpoint inhibitor pneumonitis(CIP) and explore its risk factors.Methods:The clinical data of 60 patients who received immune checkpoint inhibitors in Qingdao Municipal Hospital from March 2018 to December 2020 were analyzed retrospectively.The incidence of CIP was summarized and its clinical symptoms and imaging signs were observed.The clinical data of CIP patients and non-patients were analyzed statistically to explore the risk factors affecting CIP.Results:Among 60 patients,CIP occurred in 5 cases(3 cases G1,1 case G2,1 case G4),the incidence rate was 8.3%.1 case died and the mortality rate was 1.7%.The median time of CIP occurrence was 2.1 months(2~9 months).Clinical symptomsmainly include dyspnea,cough,fever and chest pain.Imaging findings were different,with ground glass density shadow and interlobular septum thickening in many cases,the distribution area was located around bronchial vascular bundle or subpleural area.Complicated with basic pulmonary diseases may be a risk factor for CIP.Conclusion:The incidence of checkpoint inhibitor pneumonitis is low,the clinical symptoms and imaging signs are nonspecific,there is no clear diagnostic standard.At present,there is little experience in clinical diagnosis and treatment,and severe cases can endanger life.Early detection,early diagnosis and early intervention are very important.