利妥昔单抗致间质性肺疾病1例报告及文献复习.docVIP

利妥昔单抗致间质性肺疾病1例报告及文献复习 彭印印 陈礼平 刘林 陈建斌 陈亚娟 韩晓黎 肖青 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 X 关注成功！ 加关注后您将方便地在 我的关注中得到本文献的被引频次变化的通知！ 新浪微博 腾讯微博 人人网 开心网 豆瓣网 网易微博 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。 关键词： 利妥昔单抗; 淋巴肿瘤; 间质性肺疾病; 造血干细胞移植; 感染; 作者简介：彭印印 (1988-) , 女, 重庆市人, 住院医师, 医学硕士, 主要从事临床血液学方面的研究。 作者简介：肖青, 主任医师, 硕士研究生导师 (Tel:023 E-mail:727208884@) 收稿日期：2016-11-28 基金：重庆市卫生局重点项目资助课题 (2013-1-013) Rituximab-induced interstitial lung disease:A case report and literature review PENG Yinyin CHEN Liping LIU Lin CHEN Jianbin CHEN Yajuan HAN Xiaoli XIAO Qing Department of Hematology, First Affiliated Hospital, Chongqing Medical University; Department of Respiratory Medicine, First Affiliated Hospital, Chongqing Medical University; Abstract： Objective:To discuss the pathogenesis, clinical manifestations, diagnosis, differential diagnosis, treatment, and prognosis of the patient with rituximab (RTX) -induced interstitial lung disease (ILD) (RTXILD) .Methods:A male patient aged 19 years old was confirmed as classical Hodgkins lymphoma more than2 years ago, and received autologous hemopoietic stem cell transplantation (HSCT) when the disease recurred1 year ago.Two months after HSCT, the maintenance chemotherapy was given every month with 375 mg·m-2 RTX, but the mediastinal recurrence appeared during the period, then the mediastinal residual lesion radiotherapy was done for 10 times.However, 8 dafter the third RTX chemotherapy, the patient experienced post-exercising tachypnea, fever, cough, chest congestion, and limb weakness.The chest CT scanning results suggested gro