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引用次数: 0
摘要
随着免疫检查点抑制剂(ICIs)的广泛使用,肝损伤(ICI诱导的肝损伤)作为一种免疫相关不良事件已成为临床实践中的主要关注点。由于严重的肝损伤病例需要使用皮质类固醇,因此进行全面评估至关重要,包括临床病程、血液和影像学检查,必要时通过肝活检进行病理检查。与其他药物引起的肝损伤一样,根据 R 值对损伤类型进行分类有助于决定 ICI 引起的肝损伤的治疗策略。组织学上,最具代表性的特征是急性肝炎样肝细胞损伤,其特点是弥漫性小叶炎症,伴有 CD8 阳性 T 淋巴细胞。ICI 治疗期间可能导致肝损伤的另一种情况是胆管炎,伴有非阻塞性胆管扩张和胆管壁增厚。许多 ICI 诱导的胆管炎病例被归类为非肝细胞损伤类型,据报道,这些病例对皮质类固醇的反应不佳。胃肠病学家/肝病学家和各科医生必须通力合作,建立一套系统,以实现对 ICI 引起的肝损伤的早期诊断和适当治疗。
Diagnostic guide for immune checkpoint inhibitor-induced liver injury
With the widespread use of immune checkpoint inhibitors (ICIs), liver injury (ICI-induced liver injury) as an immune-related adverse event has become a major concern in clinical practice. Because severe cases of liver injury require administration of corticosteroids, a comprehensive evaluation is crucial, including clinical course, blood and imaging tests, and if necessary, pathological examination through liver biopsy. As with liver injury induced by other drugs, classification of injury type by R-value is useful in deciding treatment strategies for ICI-induced liver injury. Histologically, the most representative feature is an acute hepatitis-like hepatocellular injury, characterized by diffuse lobular inflammation accompanied by CD8-positive T lymphocytes. Another condition that can cause liver injury during ICI treatment is cholangitis accompanied by non-obstructive bile duct dilatation and bile duct wall thickening. Many cases of ICI-induced cholangitis are classified as non-hepatocellular injury type, and they have been reported to respond poorly to corticosteroids. It is essential that gastroenterologists/hepatologists and doctors in various departments work in cooperation to develop a system that achieves early diagnosis and appropriate treatment of ICI-induced liver injury.
期刊介绍:
Hepatology Research (formerly International Hepatology Communications) is the official journal of the Japan Society of Hepatology, and publishes original articles, reviews and short comunications dealing with hepatology. Reviews or mini-reviews are especially welcomed from those areas within hepatology undergoing rapid changes. Short communications should contain concise definitive information.