免疫检查点抑制剂所致肝脏不良反应的研究进展

王宇; 李钊颖; 李爽; 刘成海

doi:10.3969/j.issn.1001-5256.2022.01.039

免疫检查点抑制剂所致肝脏不良反应的研究进展

DOI: 10.3969/j.issn.1001-5256.2022.01.039

王宇¹,
李钊颖²,
李爽¹,
刘成海^{3a, 3b, ,}

1.
上海市宝山区中西医结合医院消化科，上海 201999
2.
成都中医药大学附属医院神经内科，成都 610000
3a.
上海中医药大学附属曙光医院肝病二科，上海 201203
3b.
上海中医药大学附属曙光医院肝病研究所，上海 201203

基金项目:

上海市宝山区卫生与计划生育委员会重点专科建设 (BSK-2018-A03);

上海市卫生健康委员会科研项目计划 (20214Y0236)

利益冲突声明：所有作者均声明不存在利益冲突。

作者贡献声明：王宇负责课题设计，资料分析，撰写论文；李钊颖参与收集数据，修改论文；王宇负责拟定写作思路，刘成海、李爽指导撰写文章并最后定稿。

详细信息

通信作者:
刘成海，chenghailiu@hotmail.com

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出版历程
- 收稿日期: 2021-06-07
- 录用日期: 2021-06-28
- 出版日期: 2022-01-20

Research advances in adverse liver reactions caused by immune checkpoint inhibitors

Yu WANG¹,
Zhaoying LI²,
Shuang LI¹,
Chenghai LIU^{3a, 3b
, ,}

1.
Department of Gastroenterology, Baoshan Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai 201999, China
2.
Department of Neurology, The Affiliated Hospital of Chengdu University of Traditional Chinese Medicine, Chengdu 610000, China
3a.
Second Department of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
3b.
Institute of Liver Diseases, Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China

Research funding:

Key specialty construction of Shanghai Baoshan District Health and Family Planning Commission (BSK-2018-A03);

Shanghai Municipal Health Commission Research project plan (20214Y0236)

摘要

摘要: 免疫检查点抑制剂通过阻断T淋巴细胞负性调控信号以达到增强T淋巴细胞抗肿瘤效应的同时，也可能造成免疫耐受失衡或正常免疫亢进从而导致免疫性肝炎。本文主要通过对免疫检查点抑制剂的治疗机制，导致肝损伤的不良反应机制、危险因素以及发生率等方面进行回顾分析，并且对免疫检查点抑制剂导致肝损伤的治疗方法进行初步归纳。认为免疫检查点抑制剂在促进抗肿瘤免疫的同时，由于作用机制的非肿瘤组织靶点特异性，可能造成非同质化的免疫相关的肝损伤，治疗上以恢复免疫稳态为主。因此，免疫检查点抑制剂应用患者的管理往往需要在治疗窗、毒性和特定损伤治疗之间取得平衡，并开展多学科协作。
- 化学性与药物性肝损伤 /
- 免疫抑制剂 /
- 治疗学
Abstract: Immune checkpoint inhibitors can enhance the anti-tumor effect of T cells by blocking the negative regulatory signal of T cells, and meanwhile, they may also cause the imbalance of immune tolerance or normal immune hyperfunction, thus leading to immune hepatitis. This article mainly reviews the therapeutic mechanism of immune checkpoint inhibitors, their mechanism in causing the adverse reaction of liver injury, related risk factors, and incidence rate and summarizes the treatment methods for liver injury caused by immune checkpoint inhibitors. It is believed that while promoting anti-tumor immunity, immune checkpoint inhibitors may cause non-homogeneous immune-related liver injury due to the specificity of non-tumor tissue targets, and the main purpose of treatment is to restore immune homeostasis. Therefore, the management of patients using immune checkpoint inhibitors often requires a balance between treatment window, toxicity, and treatment of specific injury, as well as multidisciplinary collaboration.
- Chemical and Drug Induced Liver Injury /
- Immunosuppressive Agents /
- Therapeutics

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