2020 年第 7 期 第 15 卷

利妥昔单抗治疗相关的间质性肺炎临床分析

Clinical analysis of interstitial pneumonia associated with rituximab

作者：沈晶黄达永魏娜王晶石杨凌志王昭

英文作者：Shen Jing Huang Dayong Wei Na Wang Jingshi Yang Lingzhi Wang Zhao

单位：首都医科大学附属北京友谊医院血液内科100050

英文单位：Department of Hematology Beijing Friendship Hospital Capital Medical University Beijing 100050 China

关键词：B细胞非霍奇金淋巴瘤；利妥昔单抗；间质性肺炎

英文关键词：B-cellnon-Hodgkin′slymphoma；Rituximab；Interstitialpneumonia

• 摘要：

• 目的探讨含利妥昔单抗方案治疗B细胞非霍奇金淋巴瘤引起的间质性肺炎（IP）的临床特征。方法2018年11月至2019年12月首都医科大学附属北京友谊医院收治含利妥昔单抗方案治疗的CD20阳性B细胞非霍奇金淋巴瘤患者114例，其中有症状的IP患者5例，回顾性分析5例IP患者的临床资料。结果5例含利妥昔单抗方案治疗后的IP患者最常见的症状是干咳、劳累性呼吸困难和发热，其他不常见和非特异性的症状包括疲劳、气喘、咯血、皮疹和胸痛。部分患者在诊断时是无症状的，通过CT或正电子发射计算机断层显像-CT检测到间质性肺病，肺功能提示中重度弥散功能降低，血气分析提示低氧血症，严重者可表现为Ⅰ型呼吸衰竭。影像学典型表现为局限或双肺的磨玻璃影，少数也表现为斑片状实变影、结节影。经酌情停用利妥昔单抗并给予糖皮质激素治疗好转。结论含利妥昔单抗治疗方案可导致IP的发生，可能与细胞因子释放、免疫力降低及真菌或卡氏肺孢子虫感染相关，治疗上根据临床指标和影像学资料经验性应用糖皮质激素和抗卡氏肺孢子虫或抗真菌治疗，效果显著。

• ObjectiveTo investigate the clinical features of rituximab-containing regimen in the treatment of interstitial pneumonia (IP) caused by B cell non-Hodgkin's lymphoma. Methods From November 2018 to December 2019，114 CD20-positive B-cell non-Hodgkin lymphoma patients treated with rituximab admitted to Beijing Friendship Hospital， Capital Medical University were selected.  Five cases with IP were identified and the clinical features of them were investigated. Results  The most common symptoms of IP patients treated with rituximab-containing regimen were dry cough, suffocation and fever. Other uncommon and nonspecific symptoms included fatigue, asthma, hemoptysis, rash and chest pain. Some patients were asymptomatic at the time of diagnosis. Interstitial lung disease was detected by CT or positron emission tomography-CT. Pulmonary function indicated the decrease of diffusion function. Blood gas analysis indicated hypoxemia and severe patients could show type I respiratory failure. The typical manifestations of imaging were ground glass shadow of local or bilateral lungs, and a few were patchy consolidation shadow and nodular shadow. The treatment effect was improved by discontinuing rituximab and using glucocorticoid. Conclusions  The occurrence rituximab-induced IP could be related to the release of cytokines, the decrease of immunity and the infection of fungus or pneumocystis carinii (PCP). Based on the clinical data and imaging documents, we empirically treated the patients with corticosteroids and anti-PCP or antifungal therapy.