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免疫检查点抑制剂相关甲状腺不良事件的影响因素分析
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| 篇名： | 免疫检查点抑制剂相关甲状腺不良事件的影响因素分析 |
| TITLE： | Analysis of factors influencing immune checkpoint inhibitor-related thyroid adverse reactions |
| 摘要： | 目的 为促进临床合理使用免疫检查点抑制剂（ICI）提供参考。方法收集2020年1月1日至2023年12月31日于某院接受ICI治疗的患者的电子病历信息，根据患者是否发生甲状腺的免疫相关不良事件（irAE），将其分为甲状腺irAE组（又分为临床甲减、临床甲亢、亚临床甲减、亚临床甲亢4个亚组）和非甲状腺irAE组。采用单因素、多因素Logistic回归法分析ICI相关甲状腺不良事件的影响因素。结果共纳入382例接受了ICI治疗的患者，其中甲状腺irAE组共137例（占35.9%），非甲状腺irAE组共245例（占64.1%）。经单因素分析筛选后，由多因素Logistic回归分析结果可知，ICI联合放疗与甲状腺irAE的发生呈正相关[优势比（OR）＝2.157，95%置信区间（CI）（1.144，4.066），P＜0.05]，肺鳞癌与甲状腺irAE的发生呈负相关[OR＝0.600，95%CI（0.369，0.975），P＜0.05]。在各种甲状腺irAE中，鼻咽恶性肿瘤与免疫相关临床甲亢的发生呈正相关[OR＝4.678，95%CI（1.149，19.042），P＜0.05]；ICI联合放疗[OR＝2.622，95%CI（1.227，5.603），P＜0.05]、肺腺癌[OR＝2.013，95%CI（1.078，3.759），P＜0.05]与免疫相关亚临床甲亢的发生呈正相关；年龄与免疫相关临床甲减的发生呈负相关[OR＝0.944，95%CI（0.896，0.995），P＜0.05]；年龄[OR＝0.963，95%CI（0.932，0.994），P＜0.05]、ICI联合化疗[OR＝0.332，95%CI（0.137，0.802），P＜0.05]与免疫相关亚临床甲减的发生呈负相关。结论接受ICI治疗的患者中，年轻的患者更易发生甲状腺irAE。ICI联合化疗的患者更不容易发生亚临床甲减，而联合放疗会显著增加甲状腺irAE的发生风险。 |
| ABSTRACT： | OBJECTIVE To provide reference for rational clinical use of immune checkpoint inhibitor （ICI）. METHODS Electronic medical record information of patients who received ICI treatment from January 1st 2020 to December 31st 2023 at a certain hospital was collected. Patients were divided into thyroid immune-related adverse event （irAE） group （subdivided into clinical hypothyroidism， clinical hyperthyroidism， subclinical hypothyroidism， and subclinical hyperthyroidism subgroups） and non- thyroid irAE group based on whether they experienced immune-induced thyroid irAE. Univariate and multivariate Logistic regression analyses were employed to analyze the influencing factors of ICI-related thyroid adverse events. RESULTS A total of 382 patients who received ICI treatment were included， with 137 cases in the thyroid irAE group （accounting for 35.9%） and 245 cases in the non-thyroid irAE group （accounting for 64.1%）. Multivariate Logistic regression analysis， following univariate screening， revealed that ICI combined with radiotherapy was positively associated with the occurrence of thyroid irAE [odds ratio （OR）＝2.157， 95% confidence interval （CI） （1.144， 4.066）， P＜0.05]， while lung squamous cell carcinoma was negatively associated with the occurrence of thyroid irAE [OR＝0.600， 95%CI （0.369， 0.975）， P＜0.05]. Among various thyroid irAE， nasopharyngeal malignancy was positively associated with the occurrence of immune-related clinical hyperthyroidism [OR＝4.678， 95%CI （1.149， 19.042）， P＜0.05]； ICI combined with radiotherapy [OR＝2.622， 95%CI （1.227， 5.603）， P＜0.05] and lung adenocarcinoma [OR＝2.013， 95%CI （1.078， 3.759）， P＜0.05] were positively associated with the occurrence of immune-related subclinical hyperthyroidism. Age was negatively associated with the occurrence of immune-related clinical hypothyroidism [OR＝0.944， 95%CI （0.896， 0.995）， P＜0.05]； age [OR＝0.963， 95%CI （0.932， 0.994）， P＜0.05] and ICI combined with chemotherapy [OR＝0.332， 95%CI （0.137， 0.802）， P＜0.05] were negatively associated with the occurrence of immune-related subclinical hypothyroidism. CONCLUSIONS Among patients receiving ICI treatment， younger patients are more prone to thyroid irAE. Patients receiving ICI combined with chemotherapy are less likely to experience subclinical hypothyroidism， while ICI combined with radiotherapy significantly increases the risk of thyroid adverse events. |
| 期刊： | 2025年第36卷第03期 |
| 作者： | 李嘉玉；张千千；侯萌；张司棋；王可可 |
| AUTHORS： | LI Jiayu，ZHANG Qianqian，HOU Meng，ZHANG Siqi，WANG Keke |
| 关键字： | 免疫检查点抑制剂；免疫相关不良事件；甲状腺；影响因素；PD-1/PD-L1抑制剂 |
| KEYWORDS： | immune checkpoint inhibitors； immune-related adverse events； thyroid； influencing factors； PD-1/PD-L1 inhibitor |
| 阅读数： | 5 次 |
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