利妥昔单抗致间质性肺疾病1例报告及文献复习

发布时间：2018-08-07 12:42

【摘要】：目的:探讨利妥昔单抗(RTX)致间质性肺疾病(ILD)(RTX-ILD)的发病机制、临床表现、诊断、鉴别诊断、治疗和预后。方法:1例19岁男性患者,确诊经典型霍奇金淋巴瘤2+年,1年前疾病复发,复发后行自体造血干细胞移植(HSCT),移植后2个月开始每月以375mg·m-2 RTX维持化疗,期间纵隔复发行纵隔残留病灶放疗10次,第3次RTX维持治疗后第8天,患者出现活动后呼吸困难,伴发热、咳嗽、胸闷和乏力。胸部CT提示双肺多发斑片状磨玻璃影,血气分析提示低氧血症。先后给予抗细菌及抗真菌治疗,效果均不理想。后续反复多次行病原学检查均为阴性,支气管镜检查仍未见明显异常,考虑到RTX-ILD的可能,立即停用RTX并静脉给予40mg·d-1甲强龙治疗。结果:5d后患者症状好转,后续激素改为口服并逐渐减量至停用。结论:RTX-ILD相对罕见,临床表现缺乏特异性,治疗以激素为主,对激素敏感者预后较好,激素不敏感者预后较差。
[Abstract]:Objective: to investigate the pathogenesis, clinical manifestation, diagnosis, differential diagnosis, treatment and prognosis of rituximab (RTX) induced interstitial pulmonary disease (ILD) (RTX-ILD). Methods one 19-year-old male patient with classic Hodgkin's lymphoma was diagnosed for 2 years. The disease recurred one year ago. The patient received autologous hematopoietic stem cell transplantation (HSCT),) for 2 months and maintained chemotherapy with 375mg m-2 RTX every month. The patients suffered from postoperative dyspnea, fever, cough, chest tightness and fatigue 8 days after RTX maintenance therapy. Chest CT showed multiple flaky glass opacity in both lungs, and blood gas analysis suggested hypoxemia. The treatment of anti-bacterial and anti-fungal was not satisfactory. The subsequent repeated etiological examinations were negative and no obvious abnormality was found in bronchoscopy. In view of the possibility of RTX-ILD, RTX was stopped immediately and 40mg d-1 was given intravenously. Results after 5 days, the symptoms of the patients improved, the follow-up hormone was taken orally and gradually decreased to stop. ConclusionTwo one RTX-ILD is relatively rare, its clinical manifestation is lack of specificity, the main treatment is hormone, the prognosis of hormone sensitive patients is better, and the prognosis of hormone insensitive patients is poor.
【作者单位】：重庆医科大学附属第一医院血液内科;重庆医科大学附属第一医院呼吸内科;
【基金】：重庆市卫生局重点项目资助课题(2013-1-013)
【分类号】：R563.13

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