恶性肿瘤患者发生免疫检查点抑制剂相关肝损伤危险因素分析研究*

doi:10.3969/j.issn.1672-5069.2025.06.016

摘要/Abstract

摘要： 目的分析恶性肿瘤患者发生免疫检查点抑制剂(ICIs)相关肝损伤的危险因素。方法 2024年1月～12月我院收治的恶性肿瘤患者337例,均接受含ICIs抗肿瘤治疗。应用多因素Logistic回归分析恶性肿瘤患者发生ICIs相关肝损伤的危险因素。结果在337例恶性肿瘤患者中,在抗肿瘤治疗期间发生ICIs相关肝损伤31例(9.2%);肝损伤组肿瘤Ⅳ期、应用细胞毒性T淋巴细胞相关抗原4(CTLA-4)抑制剂治疗和合并肝病病史占比分别为67.7%、25.8%和32.2%,均显著高于非肝损伤组(分别为45.1%、9.2%和13.1%,P＜0.05);多因素Logistic回归分析显示,肿瘤分期(OR=2.700,95%CI:1.172～6.223,P＜0.05)、肝病病史(OR=3.619,95%CI:1.486～8.815,P＜0.05)和应用CTLA-4抑制剂(OR=1.740,95%CI:1.052～2.880,P＜0.05)均为影响恶性肿瘤患者发生ICIs相关肝损伤的独立危险因素。结论实体肿瘤患者治疗复杂,容易发生DILI。了解危险因素,做好监测,早期发现,可能提高治疗效果。

关键词: 药物性肝损伤, 恶性肿瘤, 免疫检查点抑制剂, 危险因素

Abstract: Objective The aim of this study was to investigate the risk factors for immune checkpoint inhibitors (ICIs)-associated liver injury in patients with malignant tumors. Methods A total of 337 consecutive patients with malignant tumors were admitted to our hospital between January and December 2024. All of them received anti-tumor treatment containing ICIs or ICIs with combination of other anti-tumor medicines. Multivariate Logistic regression analysis was applied to identify the risk factors for ICIs-associated liver injury in the patients. Results Of the 337 patients with malignant tumor, 31 (9.2%) patients developed ICIs-associated liver injury during anti-tumor treatment; the proportions of patients at tumor stage IV, the application of cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4) inhibitor and with a chronic liver disease history in the liver injury group were 67.7%, 25.8% and 32.2%, all significantly higher than 45.1%, 9.2% and 13.1% (P<0.05) in those without iver injury group; multivariate Logistic regression analysis showed that tumor stage (OR=2.700, 95%CI: 1.172-6.223, P<0.05), CTLA-4 inhibitor administration (OR=1.740, 95%CI: 1.052-2.880, P<0.05) and liver disease history (OR=3.619, 95%CI: 1.486-8.815, P<0.05) were the independent risk factors for occurrence of ICIs-associated liver injury in patients with malignant tumors. Conclusion Clinicians should take risk factors into consideration in order to prevent and early management of ICIs-associated liver injury.

Key words: Drug-induced Liver injury, Malignant tumor, Immune checkpoint inhibitors, Risk factor

王淼晶, 张宁, 马红, 张广全. 恶性肿瘤患者发生免疫检查点抑制剂相关肝损伤危险因素分析研究^*[J]. 实用肝脏病杂志, 2025, 28(6): 862-865.

Wang Miaojing, Zhang Ning, Ma Hong, et al. Risk factors for immune checkpoint inhibitors-associated liver injury in patients with malignant tumor[J]. Journal of Practical Hepatology, 2025, 28(6): 862-865.

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恶性肿瘤患者发生免疫检查点抑制剂相关肝损伤危险因素分析研究^*

Risk factors for immune checkpoint inhibitors-associated liver injury in patients with malignant tumor

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