重新认识免疫检查点抑制剂相关性胃炎。

IF 4.3 3区 医学 Q1 GASTROENTEROLOGY & HEPATOLOGY World Journal of Gastroenterology Pub Date : 2024-09-28 DOI:10.3748/wjg.v30.i36.4031
Ying-Fang Deng, Xian-Shu Cui, Liang Wang
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引用次数: 0

摘要

近年来,随着免疫疗法在临床上的广泛应用,取得了令人鼓舞的治疗效果。然而,在提高临床疗效的同时,也可能造成自身免疫损伤,引发免疫相关不良事件(irAEs)。免疫治疗诱发胃炎的报道逐年增多,但由于其临床症状不典型,早期诊断存在一定难度。此外,如果中断免疫治疗,还可能导致胃出血等严重并发症,增加实体瘤患者不良预后的风险。因此,全面了解免疫相关性胃炎的发病机制、临床表现、诊断标准和治疗方法,对于早期识别、诊断和治疗至关重要。此外,免疫相关性胃炎的治疗应根据每位患者的具体病情进行个性化治疗。对于2-3级irAEs患者,当症状缓解至0-1级时,可考虑重新开始免疫检查点抑制剂(ICIs)治疗。在重新开始 ICIs 治疗时,通常建议使用不同类型的 ICIs。对于 4 级 irAEs,必须永久停药。
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Reconceptualization of immune checkpoint inhibitor-associated gastritis.

In recent years, with the extensive application of immunotherapy in clinical practice, it has achieved encouraging therapeutic effects. While enhancing clinical efficacy, however, it can also cause autoimmune damage, triggering immune-related adverse events (irAEs). Reports of immunotherapy-induced gastritis have been increasing annually, but due to its atypical clinical symptoms, early diag-nosis poses a certain challenge. Furthermore, it can lead to severe complications such as gastric bleeding, elevating the risk of adverse outcomes for solid tumor patients if immunotherapy is interrupted. Therefore, gaining a thorough under-standing of the pathogenesis, clinical manifestations, diagnostic criteria, and treatment of immune-related gastritis is of utmost importance for early identification, diagnosis, and treatment. Additionally, the treatment of immune-related gastritis should be personalized according to the specific condition of each patient. For patients with grade 2-3 irAEs, restarting immune checkpoint inhibitors (ICIs) therapy may be considered when symptoms subside to grade 0-1. When restarting ICIs therapy, it is often recommended to use different types of ICIs. For grade 4 irAEs, permanent discontinuation of the medication is necessary.

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来源期刊
World Journal of Gastroenterology
World Journal of Gastroenterology 医学-胃肠肝病学
CiteScore
7.80
自引率
4.70%
发文量
464
审稿时长
2.4 months
期刊介绍: The primary aims of the WJG are to improve diagnostic, therapeutic and preventive modalities and the skills of clinicians and to guide clinical practice in gastroenterology and hepatology.
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