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免疫检查点抑制剂（immune checkpoint inhibitors,ICPis）在晚期食管癌治疗中展现出显著的生存获益，然而其潜在的内分泌系统免疫相关不良反应不容忽视。本研究报道了一例70岁男性食管癌病例，该患者先后接受卡瑞利珠单抗与替雷利珠单抗两种程序性细胞死亡蛋白-1(programmed death-1,PD-1)单克隆抗体治疗后，发生暴发性1型糖尿病（fulminant type 1 diabetes,FT1DM）并发酮症酸中毒（diabetic ketoacidosis,DKA）。临床表现为末次替雷利珠单抗治疗后突发严重高血糖（空腹血糖达17.17 mmol/L）、显著酮症（血酮浓度6.8 mmol/L）及代谢性酸中毒（血液酸碱度值7.288）。实验室检测显示患者C肽分泌严重不足（<3 pmol/L），同时存在抗胰岛细胞抗体（islet cell antibodies,ICA）和抗酪氨酸磷酸酶抗体（insulinoma-associated protein 2 antibodies,IA2）阳性。通过胰岛素替代治疗，患者代谢紊乱得到有效控制。本研究通过文献回顾，深入探讨了ICPis相关暴发性1型糖尿病的临床特征、诊断难点及管理方案，并着重指出在接受长期免疫治疗的肿瘤患者中实施内分泌系统监测的重要性。
Abstract：Immune checkpoint inhibitors(ICPis)has shown significant survival benefits in the treatment of advanced esophageal cancer, but its potential endocrine system immune-related adverse reaction cannot be ignored. This study reports a case of a 70-year-old male with esophageal cancer who developed fulminant type 1diabetes(FT1DM))with diabetic ketoacidosis(DKA)after receiving two programmed cell death protein-1(PD-1)monoclonal antibodies, carrelizumab and tislelizumab. The clinical manifestations were sudden onset of severe hyperglycemia(fasting blood glucose reached 17.17 mmol/L), significant ketosis(blood ketone concentration 6.8 mmol/L), and metabolic acidosis(p H 7.288)after the last tislelizumab treatment. Laboratory tests showed that the patient had severe C-peptide deficiency(<3 pmol/L), and was positive for islet cell antibodies(ICA)and insulinoma-associated protein 2 antibodies(IA2). Through insulin replacement therapy,the patient's metabolic disorder is effectively controlled. This study reviewed the literature and explored the clinical characteristics, diagnostic difficulties and management plans of ICPis-related fulminant type 1 diabetes,and emphasized the importance of endocrine system monitoring in cancer patients receiving long-term immunotherapy.
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基本信息:
DOI：10.20256/j.cnki.zgdxbl.20250610.002
中图分类号:R587.2;R735.1
引用信息:
[1]史蕾,阮园,孟帅.免疫检查点抑制剂诱发暴发性1型糖尿病并酮症酸中毒：1例食管癌患者的临床报道与文献复习[J].中国典型病例大全,2025,19(02):1-4.DOI:10.20256/j.cnki.zgdxbl.20250610.002.
基金信息: