アブストラクト
Japanese
| Title | 第4回 irAE胆管炎の診断と治療 |
|---|---|
| Subtitle | 胆道専門医講座 硬化性胆管炎 - 診断と治療の進歩 - |
| Authors | 川上尚人 |
| Authors (kana) | |
| Organization | 近畿大学腫瘍内科 |
| Journal | 胆道 |
| Volume | 37 |
| Number | 5 |
| Page | 912-917 |
| Year/Month | 2023 / |
| Article | 報告 |
| Publisher | 日本胆道学会 |
| Abstract | 「要旨」 : 免疫チェックポイント阻害剤 (ICI) は今や癌治療の中心的存在であり, ICIに起因する免疫関連有害事象 (irAE) のマネジメントは癌診療医にとって, いまや必須のスキルである. ICI治療後に生じた1) 閉塞のない肝外胆管の拡張 2) びまん性の肝外胆管壁肥厚 3) 胆道系酵素優位な肝障害 4) 抗核抗体や抗ミトコンドリア抗体やIgG4は正常または低値 5) CD8陽性T細胞の胆管浸潤といった特徴をもつ胆管炎を2017年に我々が報告して以降, 症例報告が相次いだが, 実際の発生頻度は0.05〜0.7%とされ比較的稀な病態である. そのため確立した診断法や治療法がなく, 臨床上の問題となっている. 本稿ではirAE胆管炎の概念や, 現時点での知見をもとにした診断・治療法について概説し, 今後解決すべき課題について論じる. |
| Practice | 臨床医学：内科系 |
| Keywords | 免疫関連有害事象, 胆管炎, 免疫チェックポイント阻害剤, irAE, cholangitis, immune checkpoint inhibitor |
English
| Title | Diagnosis and Treatment of irAE Cholangitis |
|---|---|
| Subtitle | |
| Authors | Hisato Kawakami |
| Authors (kana) | |
| Organization | Department of Medical Oncology, Kindai University Faculty of Medicine |
| Journal | JOURNAL OF JAPAN BILIARY ASSOCIATION |
| Volume | 37 |
| Number | 5 |
| Page | 912-917 |
| Year/Month | 2023 / |
| Article | Report |
| Publisher | Japan Biliary Association |
| Abstract | Immune checkpoint inhibitors (ICIs) are now the mainstay of cancer treatment, and management of immune-related adverse events (irAE) caused by ICIs is an essential skill. Since our first report in 2017 of cholangitis after ICI treatment characterized by 1) unobstructed extrahepatic bile duct dilation, 2) diffuse extrahepatic bile duct wall thickening, 3) liver damage with predominance of biliary enzymes, 4) normal or low levels of antinuclear and antimitochondrial antibodies and IgG4, and 5) infiltration of CD8 positive T cells in the bile duct, a series of case reports of irAE cholangitis have appeared. However, the actual frequency of occurrence of cholangitis is relatively rare (0.05-0.7%). Thus no established diagnostic or therapeutic methods for this disease have established so far, making it a clinical problem. In this article, we review the concept of irAE cholangitis, diagnosis and treatment based on current knowledge, and discuss issues that need to he resolved in the future. |
| Practice | Clinical internal medicine |
| Keywords | irAE, cholangitis, immune checkpoint inhibitor |
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残りの15件を表示する
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