1例广泛期小细胞肺癌患者发生免疫相关高血糖伴视神经炎病例分析与药学实践

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【中图分类号】R979.1 【文献标识码】A

【Abstract】This article reports a case of severe immune checkpoint inhibitor （ICI）- related hyperglycemia accompanied by optic neuritis in a patient with extensive-stage smallcellung cancer （ES-SCLC）.A 58-year-old male with right lung ES-SCLC and brain metastases underwent whole-brain radiotherapy followed by the first cycle of etoposide-cisplatin （EP） combined with serplulimab.Before the second treatment cycle，he developed ICI-related grade 3 hyperglycemia and grade 2-3 optic neuritis. Following intensive glucose control with intravenous insulin，the regimen was switched to combination of metformin，gliclazide，and short-acting insulin. Concurrently， intravenous methylprednisolone was given to manage optic neuritis.The patient responded well to treatment. The patient subsequently received EP chemotherapy for the second cycle. Beginning with the third cycle， immunotherapy was resumed， with serplulimab switched to atezolizumab.The patient successfull completed four cycles ofEP plus atezolizumab， during which blood glucose levels steadily declined and returned to the normal range by the sixth treatment cycle， with no recurrence of optic neuritis.The concurrent occurrence of immune-related hyperglycemia and optic neuritis in this patient introduced complexity to clinical management.The clinical pharmacist integrated pharmaceutical knowledge with clinical practice to provide personalized recommendations for the diferential diagnosis，clinical management，and therapeutic switching of immune-related adverse events， fully demonstrating thevalue of clinical pharmacists and providinga theoretical basis for the clinical diagnosis and treatment of complex immune-related toxicities.

【Keywords】Extensive-stage smallcell lung cancer; Serplulimab; Immune-related hyperglycemia Immune-related optic neuritis; Immune-related adverse events

免疫检查点抑制剂（immunecheckpointinhibitors，ICI）通过激活T细胞功能增强抗肿瘤免疫，但也可能引发免疫相关不良事件（immune-relatedadverseevents，irAEs），其中内分泌毒性较为常见，主要表现为甲状腺功能异常。（剩余11988字）