肝癌免疫治疗相关肝损伤及其临床管理OA

Hepatocellular carcinoma(HCC)is a malignant tumor with high morbidity and mortality worldwide,imposing a heavy disease burden.Immune checkpoint inhibitors(ICIs)exert antitumor effects by activating the immune system through blocking the PD-1/PD-L1 or CTLA-4 pathway,and have become the core regimen for first-and second-line treatment of advanced HCC.How-ever,while breaking immune tolerance,ICIs tend to induce multi-system immune-related adverse events(irAEs),among which immune-mediated hepatitis(IMH)is one.This review systematically summarizes the epidemiological characteristics and heteroge-neous manifestations of IMH,discusses the related risk factors,diagnostic pathways and graded treatment strategies for IMH,and ana-lyzes the impact of ICI therapy on hepatitis B virus(HBV)reactivation.It aims to provide references for the early prediction,accurate diagnosis,individualized treatment of IMH and the safety management of immunotherapy in HCC patients with HBV infection,and to offer directions for clinical practice and future research in this field.