摘要
1例56岁女性患者,诊断为“鼻咽癌颈部淋巴结复发转移”。于2021年9月15日开始行信迪利单抗注射液(200 mg,q 3 w,ivgtt)联合卡培他滨片(1.5 g,bid,d1-d14)维持治疗。2021年12月7日出现反酸、烧心、腹痛、嗳气等症状,随后查胃镜示全胃黏膜重度充血水肿,表面可见多发出血点,考虑为信迪利单抗所致免疫相关性胃炎,给予注射用甲泼尼龙琥珀酸钠(60 mg·d^(-1),ivgtt)治疗,3 d后患者症状明显好转,激素缓慢减量,6周后停用,复查胃镜示胃部病变痊愈,遂重启免疫治疗2周期。2022年4月11日患者再次出现胃肠不适症状,查胃肠镜提示炎症加重,考虑免疫性胃炎复发,再次给予注射用甲泼尼龙琥珀酸钠(60 mg·d^(-1),ivgtt)治疗后症状好转,且永久停止免疫治疗。患者出院后未遵医嘱口服激素,反复出现消化道不适症状,于2022年6月3日入院行甲泼尼龙治疗,院外遵医嘱口服泼尼松片至停药,后未再出现消化道症状。
A 56-year-old female patient was diagnosed with recurrent cervical lymph node and metastasis of nasopharyngeal carcinoma and received sintilimab injection(200 mg,q 3 w,ivgtt)combined with capecitabine tablets(1.5 g,bid,d1-d14)as maintenance therapy on September 15th,2021.She developed acid reflux,heartburn,abdominal pain,and belching on December 7th,2021.The following gastoscopy examination showed severe congestion and edema of the whole gastric mucosa and multiple visible bleeding spots on the surface,which was considered as immune-related gastritis caused by sintilimab.And methylprednisolone sodium succinate for injection(60 mg·d^(-1),ivgtt)was given to her.After 3 days,the symptoms were obviously improved.Methylprednisolone was gradually reduced and stopped after 6 weeks.Reexamination of gastroscopy showed that the gastric lesion was cured.Then immunotherapy was restarted for 2 cycles and the gastrointestinal discomfort appeared again on April 11th,2022.Recurrence of immune-related gastritis was considered after gastroscopy examination,which was improved after treatment with methylprednisolone sodium succinate for injection(60 mg·d^(-1),ivgtt)again.The immunotherapy was stopped permanently.But she did not take corticosteroids regularly outside the hospital and was admitted to hospital again due to repeated symptoms of gastrointestinal discomfort on June 3rd,2022.Methylprednisolone was given to her again,and oral prednisone tablets were taken outside the hospital.No gastrointestinal discomfort occurred again.
作者
智路路
魏盈
魏静祎
王莹楠
樊永丽
段永建
ZHI Lu-lu;WEI Ying;WEI Jing-yi;WANG Ying-nan;FAN Yong-li;DUAN Yong-jian(Department of Oncology,the First Affiliated Hospital of Henan University,Kaifeng 475001,China)
出处
《中国药物应用与监测》
CAS
2023年第2期136-138,共3页
Chinese Journal of Drug Application and Monitoring
基金
河南省医学科技攻关计划项目(LHGJ20200546)。
