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免疫检查点抑制剂相关肺炎的临床与影像研究
高鹏云
武志峰
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DOI： 10.3760/cma.j.cn112147-20210712-00487
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摘要

近年来，免疫检查点抑制剂（ICI）治疗作为各种恶性肿瘤的一线和二线治疗在临床应用越来越广泛。与常规化疗相比，ICI通过独特的作用机制攻击肿瘤细胞，但同时也可能会损害正常组织，导致免疫相关不良事件。ICI相关肺炎是ICI治疗过程中不太常见但较为严重的免疫相关不良事件。其临床表现多变且缺乏特异性，CT影像在诊断和疗效评估中起着重要作用。

引用本文

高鹏云,武志峰. 免疫检查点抑制剂相关肺炎的临床与影像研究[J]. 中华结核和呼吸杂志,2022,45(02)：238-242.

DOI:10.3760/cma.j.cn112147-20210712-00487

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近些年来，以免疫检查点抑制剂（immune checkpoint inhibitors，ICI）为代表的免疫治疗广泛应用于各种恶性肿瘤的治疗，特别是非小细胞肺癌和黑色素瘤 ［ 1 ］ ，有效延长了肿瘤患者的生存期。免疫治疗是利用免疫系统抑制肿瘤细胞免疫逃逸，从而抑制了肿瘤的异常增殖。然而ICI在介导活化T细胞攻击肿瘤细胞的同时可能会损害正常组织，导致免疫相关不良事件（immune-related adverse events，irAEs）。
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附录
问答题（单选题）

1.关于ICI相关肺炎的发病机制，下列说法正确的是（）

A.与肿瘤和其他正常组织共有的自身抗原活性增高；

B.与事先存在的自身抗体的激活及细胞因子水平及补体增加相关；

C.与排斥性导向分子b（RGMb）和PD-L2间相互作用有关；

D.以上都正确

2.关于ICI相关肺炎的流行病学，下列说法正确的是（）

A.ICI相关肺炎发生率为3%~6%；

B.ICI相关肺炎中位发病时间为2~3个月；

C.免疫治疗前存在的肺部疾病史、吸烟史及有放疗病史的患者，ICI相关肺炎的发生率明显增高；

D.以上皆为正确

3.关于ICI相关肺炎OP模式的影像学表现，下列说法错误的是（）

A.胸膜下和（或）支气管周围分布的斑片状实变影，中下肺为主；

B.新月状或环状致密影包绕磨玻璃密度区（环礁征或反晕征）；

C.双肺下叶后部胸膜下相对不累及；

D.双肺弥漫分布、边缘模糊的小叶中心磨玻璃小结节少有报道

4.对于ICI相关肺炎的RRP模式的描述，下列说法正确的是（）

A.诱发RRP的药物包括ICI、吉非替尼、紫杉醇曲妥珠单抗等；

B.RRP发生率为18.8%，RRP中位发病时间是放疗结束后30~90 d；

C.RRP影像学表现为与先前放射野密切吻合的斑片状实变或均匀磨玻璃影，与正常组织分界不清晰；

D.以上都正确

5.关于ICI相关肺炎SLR模式的描述，下列说法错误的是（）

A.SLR典型组织学表现为中央非干酪性上皮样巨细胞、多核巨细胞为主，周围淋巴细胞散在浸润；

B.SLR典型CT表现为双下肺部为著的磨玻璃影、不规则网格影；

C.SLR典型CT表现为双肺沿淋巴管周围分布的粟粒结节，纵隔和双侧肺门淋巴结肿大；

D.SLR可表现为脾脏受累，即多发局灶性未强化低密度影

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备注信息
A
武志峰，Email： mocdef.6ab214002gnefihzuw
B

高鹏云, 武志峰. 免疫检查点抑制剂相关肺炎的临床与影像研究[J]. 中华结核和呼吸杂志, 2022, 45(2): 238-242. DOI: 10.3760/cma.j.cn112147-20210712-00487.

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