背景:程序性细胞死亡1(PD-1)抑制剂是免疫检查点抑制剂(ICI),已证明在治疗各种晚期恶性肿瘤中具有显着的功效。虽然大多数患者能很好地耐受治疗,几种药物不良反应,比如疲劳,骨髓抑制,和ICI相关的结肠炎,已被报道。
方法:该病例涉及一名57岁的男性溃疡性结肠炎合并肝癌患者,接受了替瑞珠单抗(PD-1抑制剂)治疗6个月。治疗导致反复危及生命的下消化道出血。患者接受英夫利昔单抗,维多珠单抗,和其他抢救程序,但由于无法控制的大量下消化道出血,最终需要结肠次全切除术。目前,术后消化道出血已经停止,病人的大便变黄了,他的全血细胞计数已经恢复正常.
结论:这个案例突出了早期识别的必要性,及时和充分治疗ICI相关的结肠炎,并迅速升级以达到改善预后的目的。
BACKGROUND: Programmed cell death 1 (PD-1) inhibitors are immune checkpoint inhibitors (ICI) that have demonstrated significant efficacy in treating various advanced malignant tumors. While most patients tolerate treatment well, several adverse drug reactions, such as fatigue, myelosuppression, and ICI-associated colitis, have been reported.
METHODS: This
case involved a 57-year-old male patient with ulcerative colitis complicated by
hepatocarcinoma who underwent treatment with tirelizumab (a PD-1 inhibitor) for six months. The treatment led to repeated life-threatening lower gastrointestinal hemorrhage. The patient received infliximab, vedolizumab, and other salvage procedures but ultimately required subtotal colectomy due to uncontrollable massive lower gastrointestinal bleeding. Currently, postoperative gastrointestinal bleeding has stopped, the patient\'s stool has turned yellow, and his full blood cell count has returned to normal.
CONCLUSIONS: This
case highlights the necessity of early identification, timely and adequate treatment of ICI-related colitis, and rapid escalation to achieve the goal of improving prognosis.