2024 年第 11 期 第 19 卷

免疫检查点抑制剂相关甲状腺功能减退的机制探索及诊疗进展

Investigation of the mechanism and advancements in diagnosis and management of hypothyroidism triggered by immune checkpoint inhibitors

作者：胡金鸿1杨吉利2程祺2王燕1曾传富1张生娇1

英文作者：Hu Jinhong1 Yang Jili2 Cheng Qi2 Wang Yan1 Zeng Chuanfu1 Zhang Shengjiao1

单位：1长春中医药大学，长春130117；2吉林省肿瘤医院中西医结合科，长春130012

英文单位：1Changchun University of Chinese Medicine Changchun 130117 China; 2Department of Integrated Traditional Chinese and Western Medicine Jilin Cancer Hospital Changchun 130012 China

关键词：甲状腺功能减退；免疫检查点抑制剂；免疫相关不良反应

英文关键词：Hypothyroidism;Immunecheckpointinhibitors；Immune-relatedadverseevents

• 摘要：

• 免疫检查点抑制剂（ICI）的问世标志着肿瘤免疫治疗新时代的到来，为肿瘤患者带来了前所未有的长期生存获益。ICI目前广泛应用于肿瘤的多线治疗中，然而大量的临床数据表明其在治疗获益的同时也可能导致免疫相关不良事件（irAEs）的发生。其中ICI相关甲状腺功能减退（irH）是最常见的irAEs之一。因其起病有隐匿性，且病情进展相对缓慢，临床上多易漏诊，严重者可能会出现黏液性水肿昏迷、心力衰竭、呼吸衰竭等严重并发症，这为患者的治疗和预后带来了不小的挑战，所以正确地认识和有效管理irH，对提高肿瘤患者安全性和改善预后至关重要。本文将从发病机制、危险因素、诊断标准、现代医学治疗、中医药干预等方面对irH进行综述。

• The emergence of immune checkpoint inhibitors (ICI) marks the arrival of a new era in cancer immunotherapy, bringing unprecedented long-term survival benefits to cancer patients. ICI is currently widely used in multi-line treatment of cancer, but a large amount of clinical data shows that it may also lead to the occurrence of immune-related adverse events (irAEs) while bringing therapeutic benefits. Among them, ICI-related hypothyroidism (irH) is one of the most common irAEs.Because it has a hidden onset and the disease progresses relatively slowly, it is often missed in clinical practice. Severe cases may lead to mucous edema coma, heart failure, and respiratory failure, which pose significant challenges for treatment and prognosis. Therefore, it is crucial to correctly understand and effectively manage irH to improve the safety and prognosis of cancer patients. This article will provide a comprehensive review of irH, including its pathogenesis, risk factors, diagnostic criteria, modern medical treatment, and Chinese medicine intervention.