在不同临床场景中诊断检查点抑制剂诱导的糖尿病：更新诊断标准的实际应用
Reaching the Diagnosis of Checkpoint Inhibitor-Induced Diabetes Mellitus in Different Clinical Scenarios: A Real-World Application of Updated Diagnostic Criteria.
作者信息
Angelousi Anna, Ziogas Dimitrios C, Siampanopoulou Vasiliki, Mytareli Chrysoula, Anastasopoulou Amalia, Lyrarakis George, Gogas Helen
机构信息
First Department of Internal Medicine, Unit of Endocrinology, Laikon Hospital, Center of Excellence of Endocrine Tumours (ERN), National and Kapodistrian University of Athens, 11527 Athens, Greece.
First Department of Medicine, Laiko General Hospital, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece.
出版信息
Diseases. 2024 Feb 14;12(2):40. doi: 10.3390/diseases12020040.
BACKGROUND
Checkpoint inhibitor (CPI)-associated diabetes mellitus (CPI-DM) is a rare immune-related adverse event (irAE) that presents with variable clinical manifestations. Data about its pathogenesis have not yet been adequately studied.
METHODS
Applying the recently updated diagnostic criteria from the American Diabetes Association, we retrospectively reviewed the medical records of all CPI-treated patients referred to our endocrinological unit for managing their endocrine irAEs and analyzed the incidence of CPI-DM, its clinical characteristics, and its management.
RESULTS
Among the 326 CPI-treated patients with endocrine irAEs, 4 patients met the updated criteria for the diagnosis of CPI-DM, representing 1.22% of all endocrine irAEs in our cohort. These four patients presented with distinct clinical scenarios regarding the irAE onset, the underlying malignancy, the administered CPI regimen, and the type of circulating autoantibodies.
CONCLUSION
The variable presentation of CPI-DM and the non-standard sensitivity of the presence of the type 1 DM traditional autoantibodies highlight the need for distinct guidelines and increased awareness of its diagnosis and management.
背景
检查点抑制剂（CPI）相关糖尿病（CPI-DM）是一种罕见的免疫相关不良事件（irAE），临床表现多样。关于其发病机制的数据尚未得到充分研究。
方法
应用美国糖尿病协会最近更新的诊断标准，我们回顾性分析了所有因内分泌irAE转诊至我们内分泌科接受治疗的CPI治疗患者的病历，分析了CPI-DM的发病率、临床特征及其管理。
结果
在326例接受CPI治疗且患有内分泌irAE的患者中，4例符合CPI-DM的更新诊断标准，占我们队列中所有内分泌irAE的1.22%。这4例患者在irAE发作、潜在恶性肿瘤、所使用的CPI方案以及循环自身抗体类型方面呈现出不同的临床情况。
结论
CPI-DM的表现多样以及1型糖尿病传统自身抗体存在的非标准敏感性凸显了制定明确指南以及提高对其诊断和管理认识的必要性。
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