胸腔病例（三七三）免疫檢查點抑制劑肺炎

10.6666/ClinMed.202102_87(2).0020

江侑洵；黃煦晴

非小細胞肺癌（non-small cell lung cancer） ； 免疫相關副作用（immune -related adverse effect） ； 免疫檢查點抑制劑肺炎（checkpoint inhibitor pneumonitis） ； 支氣管肺泡沖洗術（braonchoalveoloar lavage, BAL）

臨床醫學月刊

87卷2期（2021 / 02 / 26）

127 - 131

繁體中文

近年在非小細胞肺癌的治療中，免疫檢查點抑制劑（immunocheckpoint inhibitors, ICI）已於臨床試驗中證實能改善存活率。其副作用為免疫系統被激活攻擊正常組織所導致，在臨床上稱為免疫相關副作用（immune-related adverse effect, irAE）。其中以免疫相關肺炎的死亡率最高，但因其影像無特異性，因此病患用藥史為重要依據。當臨床上懷疑免疫相關肺炎且病人有症狀時，需即時以類固醇治療，並同時排除其它可能診斷。本案例為一名55歲男性病患，診斷為第四期非小細胞肺癌。在使用pembrolizumab 4個月後出現呼吸喘的症狀，胸部x光和電腦斷層顯示雙肺葉多處毛玻璃樣變化，因此懷疑為免疫檢查點抑制劑肺炎（checkpoint inhibitor pneumonitis, CIP）。病患隨即接受類固醇治療，並於次日行支氣管肺泡沖洗術（braonchoalveoloar lavage, BAL）排除其它可能診斷。病人經治療後症狀逐漸改善，後續接受肺癌的化學治療。

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