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免疫检查点抑制剂相关性肝损伤的研究进展
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Abstract:
免疫治疗在肿瘤治疗中的应用日益广泛，免疫检查点抑制剂(Immune checkpoint inhibitors, ICI)在多种恶性肿瘤患者中显示出显著的疗效，然而，它们与影响包括肝脏在内的许多器官的广泛免疫相关毒性有关。ICI治疗相关性肝损伤也逐渐受到关注，目前的研究进展主要集中在发病机制、发生率、临床表现等方面，虽然对ICI的认识不断加强，但在免疫检查点抑制剂治疗期间发生的免疫介导的肝炎的处理和管理可能是具有挑战性的，本文旨在对免疫相关性肝损伤的危险因素、发病机制、病理表现、影像学特征诊断及治疗等进行综述，旨在为临床管理提供参考，全方位、系统地评估引起肝损的相关危险因素及严重程度，及时预测、识别和管理ICI以降低ICI的发生风险，掌握规范的治疗方案，进而让更多接受ICI治疗的肿瘤患者在受益的同时减少ICI的发生。
The application of immunotherapy in tumor treatment is becoming increasingly widespread, and immune checkpoint inhibitors (ICI) have shown significant efficacy in various malignant tumor patients. However, they are associated with widespread immune related toxicity affecting many organs, including the liver. The treatment of ICI related liver injury is gradually receiving attention, and current research progress mainly focuses on the pathogenesis, incidence, clinical manifestations, and other aspects. Although the understanding of ICI is constantly strengthening, the treatment and management of immune-mediated hepatitis during immune checkpoint inhibitor treatment may be challenging. This article aims to review the risk factors, pathogenesis, pathological manifestations, imaging features diagnosis and treatment of immune-mediated liver injury, aiming to provide reference for clinical management, comprehensively and systematically evaluate the relevant risk factors and severity of liver injury, timely predict, identify and manage ICI to reduce the risk of ICI occurrence, master standardized treatment plans, and enable more tumors receiving ICI treatment. Patients benefit while reducing the occurrence of ICI.
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