免疫检查点抑制剂相关胰腺炎的研究进展

Research progress in diagnosis and treatment of immune checkpoint inhibitor-associated pancreatitis

摘要:

免疫检查点抑制剂（ICI）相关胰腺炎是ICIs罕见的消化道不良反应，目前发病机制尚不明确，推测可能与ICIs触发非特异性炎症T细胞介导的免疫反应有关；ICIs联合用药、黑色素瘤、65岁以下人群及既往有胰腺炎病史均是其危险因素。ICIs相关胰腺炎可表现为伴或不伴症状的胰酶升高，其诊断依赖于病史、实验室评估及影像学检查。ICIs相关胰腺炎可采用与经典急性胰腺炎相似的方式进行管理，其治疗主要包括液体复苏和疼痛控制，以及并发症防治。其中糖皮质激素是中、重度ICIs相关胰腺炎治疗的基石，传统免疫抑制剂及生物制剂的应用仍需进一步开发。

Abstract:

Immune checkpoint inhibitors (ICIs)-associated pancreatitis is a rare gastrointestinal adverse reaction of ICIs. At present, its pathogenesis is still unclear, and it is speculated that it may be related to the non-specific inflammatory T cell-mediated immune response triggered by ICIs. ICIs combination therapy, melanoma, individuals under 65 years old, and a history of pancreatitis are all risk factors. ICIs-associated pancreatitis may present with or without symptomatic elevation of pancreatic enzymes, and its diagnosis depends on medical history, laboratory evaluation and imaging examinations. ICIs-associated pancreatitis can be managed in a similar manner to classical acute pancreatitis, with treatment primarily consisting of fluid resuscitation and pain control, as well as the prevention and treatment of complications. Glucocorticoids are the cornerstone of the treatment of moderate and severe ICIs-associated pancreatitis. And the application of traditional immunosuppressants and biologics still needs further development.