非小细胞肺癌患者发生免疫检查点抑制剂相关性肺炎的危险因素研究

Risk factors for immune checkpoint inhibitor-related pneumonitis in patients with non-small cell lung cancer

摘要:

目的 探讨非小细胞肺癌（NSCLC）患者在接受免疫检查点抑制剂（ICIs）治疗过程中发生免疫检查点抑制剂相关性肺炎（CIP）的危险因素。方法 回顾性分析2020年1月—2024年3月在镇江市第一人民医院接受ICIs治疗NSCLC患者（150例）的病历资料。根据是否发生CIP分为CIP组（52例）和非CIP组（98例）。采用单因素分析和多因素一般Logistic回归模型评估影响CIP发生的独立危险因素。结果 CIP组白蛋白（ALB）和抗血管治疗率均低于非CIP组（P <0.05）；CIP组CD3⁺和CD8⁺水平均高于非CIP组（P <0.05）；多因素一般Logistic回归分析结果显示：未进行抗血管治疗［O^R=0.079（95% CI：0.025，0.251）］、ALB水平低［O^R=0.623（95% CI：0.513，0.757）］、CD3⁺水平高［O^R=1.192（95% CI：1.083，1.312）］、CD4⁺水平低［O^R=0.848（95% CI：0.787，0.913）］、CD8⁺水平高［O^R=1.226（95% CI：1.147，1.310）］均为NSCLC患者发生CIP的危险因素（P <0.05）。结论 抗血管治疗、ALB、CD3⁺、CD4⁺、CD8⁺水平是NSCLC患者发生CIP的独立危险因素。通过监测这些指标，能够有效预测CIP的发生风险，为临床治疗提供重要参考。

Abstract:

Objective To investigate the risk factors for the occurrence of immune checkpoint inhibitor (ICI)-related pneumonitis (CIP) in patients with non-small cell lung cancer (NSCLC) undergoing ICI therapy.Methods A retrospective study enrolled 150 NSCLC patients treated with ICIs at Zhenjiang First People's Hospital between January 2020 and March 2024. Patients were categorized into a CIP group (n = 52) and a non-CIP group (n = 98) based on CIP occurrence. Clinical data were collected for both groups. Univariable analysis and multivariable logistic regression analysis were employed to evaluate independent risk factors for CIP development.Results The CIP group exhibited lower serum albumin (ALB) levels and anti-angiogenic therapy rates than the non-CIP group (P < 0.05), while higher CD3⁺ and CD8⁺ levels were observed in the CIP group (P < 0.05). Multivariable logistic regression analysis revealed that absence of anti-angiogenic therapy [O^R = 0.079 (95% CI: 0.025, 0.251) ], low ALB levels [O^R = 0.623 (95% CI: 0.513, 0.757) ], high CD3⁺ levels [O^R = 1.192 (95% CI: 1.083, 1.312) ], low CD4⁺ levels [O^R = 0.848 (95% CI: 0.787, 0.913) ], and high CD8⁺ levels [O^R = 1.226 (95% CI: 1.147, 1.310) ] were all risk factors for CIP occurrence in NSCLC patients (P < 0.05).Conclusion Anti-angiogenic therapy and levels of ALB, CD3⁺, CD4⁺, and CD8⁺ are independent risk factors for CIP in NSCLC patients. Monitoring these factors enables effective prediction of CIP risk and provides valuable guidance for clinical management.