免疫检查点抑制剂相关性肺炎的临床特征及中医病机初探OA

Objective To analyze the clinical characteristics of patients with checkpoint inhibitor pneumonitis(CIP)of different grades and explore traditional Chinese medicine(TCM)pathogenesis to enrich the TCM understanding of immune therapy-related adverse reactions(irAEs).Methods Patients who were hospitalized and underwent CIP at the Cancer Center of The First Affiliated Hospital of Guangzhou University of Chinese Medicine from January 2022 to December 2024 were selected as the study subjects.Clinical data of the patients were collected,and they were divided into a low-grade group(n=27)and a high-grade group(n=28).The clinical characteristics,laboratory test indicators,TCM four diagnostic information,syndrome types,treatment approaches,and prognoses of the two groups were analyzed and compared.Results A total of 55 CIP patients were collected.The proportion of patients with a smoking history and the neutrophil count in the high-grade group were higher than those in the low-grade group,while the platelet count was lower(all P＜0.05).In terms of TCM features,shortness of breath and yellow tongue coating were associated with high-grade CIP.Regarding syndrome type distribution,the low-grade group was mainly characterized by phlegm-dampness syndrome(48.15%),while the high-grade group was mainly characterized by qi-deficiency syndrome(32.14%).The TCM pathogenesis involved excess syndromes primarily manifested as phlegm-dampness and heat-toxicity,and deficiency syndromes manifested as qi-deficiency and yin-deficiency.For treatment,the basic TCM formulas were Erchen Decoction in phlegm-dampness syndrome and Liujunzi Decoction in qi-deficiency syndrome.The prognosis was favorable in the low-grade group and poorer in the high-grade group,and the proportion of patients achieving complete remission or improvement in the low-grade group was higher than that in the high-grade group(74.07%vs 32.14%).The median time to improvement was 26(19,50)days in the TCM-only treatment group and 30(24,57)days in the integrated Chinese and Western medicine treatment group.Among 6 patients who underwent immunotherapy rechallenge,only 1(16.67%)experienced recurrence.Conclusion Aggravated symptoms,decreased platelet count,and elevated neutrophils in CIP patients may indicate the potential for disease deterioration.The TCM pathogenesis of CIP is characterized by deficiency in the root and excess in the manifestation,with the phlegm-dampness syndrome being the most common among CIP patients.The combination of traditional Chinese medicine with standard Western medical treatment helps shorten the course of CIP and reduce the recurrence rate,providing an advantageous option for the treatment of low-grade CIP.