Pembrolizumab引起的肝炎越来越受到关注,而帕博利珠单抗诱导的胆管炎知之甚少。这项研究调查了临床特征,治疗,和pembrolizumab诱导的胆管炎的结果。病例报告,通过检索从开始到2023年10月30日的中英文数据库,收集了pembrolizumab诱导的胆管炎的病例系列和临床研究.50名胆囊炎患者进入我们的研究,中位年龄为68岁(范围48、89)。胆囊炎发病的中位时间为1.1个月(范围0.3,24),初始给药后的中位周期数为5个周期(范围1,27).大多数患者没有临床症状,仅表现为胆汁酶升高(24例,48.0%),而一些患者出现黄疸(12例,24.0%),腹痛(10例,20.0%)和发热(7例,14.0%)。碱性磷酸酶的中值为1111IU(范围130,3515),谷氨酰转移酶的中值为649.5IU(范围159,3475)。胆囊的影像学表现为胆管扩张,狭窄和胆管壁增厚和不规则。胆管活检显示炎性浸润,主要是CD8+T细胞浸润。免疫抑制治疗4例(8.0%)完全缓解,部分缓解28例(56.0%),15例(30.0%)反应不佳。胆管炎是pembrolizumab的一种罕见且严重的不良反应。临床医生在使用pembrolizumab时应意识到胆管炎的可能性。类固醇对大多数胆囊炎患者可能无效,和熊去氧胆酸可能是一个选择。
Pembrolizumab induced hepatitis has received increasing attention, while pembrolizumab induced
cholangitis is poorly understood. This study investigated the clinical features, treatment, and outcome of pembrolizumab induced
cholangitis. Case reports, case series and clinical studies of pembrolizumab induced
cholangitis were collected by retrieving English and Chinese database from inception until October 30, 2023. Fifty patients with cholecystitis entered our study with a median age of 68 years (range 48, 89). The median time to onset of cholecystitis was 1.1 months (range 0.3, 24), and the median number of cycles was 5 cycles (range 1, 27) after initial administration. Most of the patients had no clinical symptoms and only showed elevated biliary enzymes (24 cases, 48.0%), while some patients showed jaundice (12 cases, 24.0%), abdominal pain (10 cases, 20.0%) and fever (7 cases, 14.0%). The median alkaline phosphatase value was 1111 IU(range 130, 3515) and the median glutamyltransferase value was 649.5 IU(range 159, 3475). The imaging features of gallbladder were bile duct dilatation, stenosis and bile duct wall thickening and irregularity. Bile duct biopsy showed inflammatory infiltration, mainly CD8 + T cell infiltration. Immunosuppression treatment resulted in complete response in 4 cases (8.0%), partial response in 28 cases (56.0%), and poor response in 15 cases (30.0%).
Cholangitis is a rare and serious adverse effect of pembrolizumab. Clinicians should be aware of the possibility of
cholangitis when administering pembrolizumab. Steroids may not be effective in most patients with cholecystitis, and ursodeoxycholic acid may be an option.