免疫相关性膀胱炎诊治现状与进展

Current status and advances in the diagnosis and treatment of immune-related cystitis

摘要

随着人口老龄化及免疫检查点抑制剂在老年肿瘤患者中应用的增加，相关免疫不良反应的识别与管理日益重要。免疫相关性膀胱炎（irC）是少见但易漏诊的泌尿系统免疫相关不良反应，常表现为新发或加重的尿频、尿急、尿痛、夜尿增多及血尿。老年患者常合并前列腺增生、膀胱过度活动、慢性尿路感染史、泌尿系统肿瘤或盆腔治疗史，且多药治疗和肾功能储备下降较常见，使irC易被误认为普通尿路感染、原有下尿路疾病进展或肿瘤相关表现。反复尿培养阴性、抗生素治疗效果不佳是重要诊断线索，部分患者可合并输尿管炎、肾积水甚至急性肾损伤。本文围绕irC的命名、流行病学、发病机制、临床表现、诊断鉴别、治疗及随访进展进行综述，重点探讨其在老年及共病肿瘤患者中的识别难点和分级处理策略，以期为临床早期诊断、规范治疗和长期管理提供参考。

Abstract

With the aging of population and the increasing use of immune checkpoint inhibitors in elderly patients with cancer，the recognition and management of immune-related adverse events have become increasingly important. Immune-related cystitis（irC）is an uncommon but easily missed urinary immune-related adverse event. It commonly presents with new-onset or worsening urinary frequency，urgency，dysuria，nocturia，and hematuria. In elderly patients，benign prostatic hyperplasia，overactive bladder，previous chronic urinary tract infection，urological malignancy，pelvic treatment history，polypharmacy，and reduced renal reserve may complicate clinical assessment，making irC easily misdiagnosed for ordinary urinary tract infection，progression of pre-existing lower urinary tract diseases，or tumor-related manifestations. Repeatedly negative urine cultures and poor response to antibiotics are important diagnostic clues. Some patients may develop ureteritis，hydronephrosis，or even acute kidney injury. This review summarizes current progress in the nomenclature，epidemiology，pathogenesis，clinical manifestations，diagnosis，differential diagnosis，treatment，and follow-up of irC，with particular attention to its recognition and stratified management in elderly patients with cancer and multimorbidity.

关键词

免疫相关性膀胱炎 / 免疫性膀胱炎 / 免疫检查点抑制剂 / 程序性死亡受体1/程序性死亡配体1（PD-1/PD-L1） / 免疫相关不良反应 / 老龄化 / 共病

Key words

immune-related cystitis / immune cystitis / immune checkpoint inhibitors / PD-1/PD-L1 / immune-related adverse events / aging / multimorbidity

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