艰难梭菌感染叠加免疫介导的腹泻和结肠炎一例

A Case of Clostridium difficile Infection Superimposed on Immune-Mediated Diarrhea and Colitis

摘要: 免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)联合化疗是转移性非小细胞肺癌(non-small cell lung cancer, NSCLC)的一线标准治疗，可显著改善患者长期生存，但免疫相关不良反应(immune-related adverse events, irAEs)的发生可能影响治疗进程，其中肠道毒性是常见的irAEs之一，主要表现为ICIs导致的免疫介导的腹泻和结肠炎(immune-mediated diarrhea and colitis, IMDC)，由于艰难梭菌感染(Clostridium difficile infection, CDI)与IMDC的临床表现存在重叠，两者所致腹泻的鉴别具有一定挑战性，若处理不当可能导致治疗中断或危及患者生命安全，因此及时鉴别诊断、规范毒性管理及合理制定ICIs再挑战策略，对保障治疗获益至关重要。本文报道1例转移性NSCLC患者接受ICIs及化疗治疗中出现CDI叠加IMDC的诊疗过程，为转移性NSCLC患者ICIs相关腹泻和结肠炎提供临床参考。

Abstract: Immune checkpoint inhibitors (ICIs) combined with chemotherapy are the first-line standard treatment for metastatic non-small cell lung cancer (NSCLC), which can significantly improve the long-term survival of patients, but the occurrence of immune-related adverse events (irAEs) may affect the treatment process, among which intestinal toxicity is one of the common irAEs, mainly manifested as immune-mediated diarrhea and colitis (IMDC) caused by ICIs. Due to the overlap in the clinical manifestations of Clostridium difficile infection (CDI) and IMDC, it is challenging to dif-ferentiate diarrhea caused by the two, and if not properly handled, it may lead to treatment inter-ruption or endanger the patient’s life. Therefore, timely differential diagnosis, standardized toxicity management, and the rational development of ICIs re-challenge strategies are crucial to ensuring treatment benefits. This article reports the diagnosis and treatment of CDI superimposed on IMDC in a patient with metastatic NSCLC receiving ICIs and chemotherapy, which provides a clinical ref-erence for ICIs-related diarrhea and colitis in patients with metastatic NSCLC.