肺癌患者免疫治疗所致肝损伤的影响因素

肝脏 ›› 2023, Vol. 28 ›› Issue (6): 688-693.

肺癌患者免疫治疗所致肝损伤的影响因素

王涵, 彭瑾, 金慧茹, 王潇, 戴晶晶, 李军, 蒋龙凤

210029 江苏南京医科大学第一附属医院感染病科

收稿日期:2023-02-20 出版日期:2023-06-30 发布日期:2023-08-30
通讯作者: 蒋龙凤,Email:longfengjiang@njmu.edu.cn
基金资助:
省科技厅基础研究计划(自然科学基金)(BK20161059)

An analysis on the influencing factors of liver injury caused by immunotherapy in lung cancer patients

WANG Han, PENG Jin, JIN Hui-ru, WANG Xiao, DAI Jing-jing, Li Jun, JIANG Long-feng

Department of Infectious Diseases, the First Affiliated Hospital with Nanjing Medical University,Nanjing 210029,China

Received:2023-02-20 Online:2023-06-30 Published:2023-08-30
Contact: JIANG Long-feng,Email:longfengjiang@njmu.edu.cn

摘要/Abstract

摘要： 目的探究免疫治疗肺癌患者出现免疫介导性肝损伤的特征及其影响因素。方法回顾性分析2018年7月至2021年7月南京医科大学第一附属医院接受免疫治疗且肺癌患者的临床资料。根据是否在免疫治疗期间出现转氨酶升高分为非肝损伤组189例和肝损伤组81例,根据治疗方案分为单免疫治疗组25例,免疫联合抗血管生成组6例及免疫联合化疗组50例。比较各组间临床资料。结果肝损伤组女性患者的比例为30.86%(25/81),高于非肝损伤组的18.52%(35/189)(P=0.025)。肝损伤组免疫治疗前的淋巴细胞计数[1.52(1.13,1.94),P=0.010]、红细胞[4.29(3.96,4.67),P=0.004]及血红蛋白水平[131.00(121.50,145.00),P<0.01]偏高,而中性粒细胞计数/淋巴细胞计数[2.62(1.86,3.98),P=0.004]及血小板/淋巴细胞计数[132.39(92.60,183.27),P<0.01]偏低。多因素logistic回归分析显示,性别(P=0.018,OR=2.142,95%CI:1.137~4.035)是独立危险因素,不同免疫治疗方案之间,免疫联合化疗组的患者出现转氨酶升高更早。结论免疫介导性肝损伤的患者临床症状不典型,在女性患者中较为多见,与年龄、病理类型、基础疾病等没有明显的相关,性别是其独立危险因素。

关键词: 免疫检查点抑制剂, 药物性肝损伤, 肺癌

Abstract: Objective To explore the characteristics and influencing factors of immunotherapy-mediated liver injury in lung cancer patients. Methods The clinical data of lung cancer patients with complete information who received immunotherapy with Immune checkpoint inhibitors (ICIs) from July 2018 to July 2021 were retrospectively analyzed. The patients were divided into non-liver injury group (n=189) and liver injury group (n=81) according to whether they had liver function abnormalities during immunotherapy. Alternatively, they were divided into immunotherapy group (n=25), immunotherapy combined with anti-angiogenic agents group (n=6), and immunotherapy combined with chemotherapy group (n=50) according to different treatment regimes, and the clinical data among all groups were compared. Results The proportion of female patients in the liver injury group was higher than that in the non-liver injury group (30.86% vs 18.52%,P=0.025). The lymphocyte count [1.52 (1.13, 1.94),P=0.010], erythrocyte level [4.29 (3.96,4.67),P=0.004] and hemoglobin level [131.0 0(121.50, 145.00),P<0.001] before immunotherapy in the liver injury group were higher. However, neutrophil count/lymphocyte count [2.62 (1.86, 3.98),P=0.004] and platelet/lymphocyte count [132.39 (92.60,183.27),P<0.001] were lower. Multiple logistic regression analysis showed that gender (P=0.018, OR=2.142, 95%CI 1.137-4.035) was an independent risk factor. Between different immunotherapy regimens, patients in the immunotherapy combined with chemotherapy group showed earlier elevation of transaminase. Conclusion The clinical symptoms of patients with immune-mediated hepatitis are not typical, which is more common in female patients. There is no obvious correlation between the liver injury with age, pathological type, underlying disease, whereas gender is an independent risk factor.

Key words: Immune checkpoint inhibitors;Drug-induced liver injury;Lung cancer

王涵, 彭瑾, 金慧茹, 王潇, 戴晶晶, 李军, 蒋龙凤. 肺癌患者免疫治疗所致肝损伤的影响因素[J]. 肝脏, 2023, 28(6): 688-693.

WANG Han, PENG Jin, JIN Hui-ru, WANG Xiao, DAI Jing-jing, Li Jun, JIANG Long-feng. An analysis on the influencing factors of liver injury caused by immunotherapy in lung cancer patients[J]. Chinese Hepatolgy, 2023, 28(6): 688-693.

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