引用文本：陈斌锋, 赵继军. 免疫检查点抑制剂相关消化系统不良事件：从发病机制到临床管理[J/CD]. 消化肿瘤杂志（电子版）, 2026, 18(2): 234-245.

作者：陈斌锋，赵继军

单位：中山大学附属第一医院风湿免疫科，广东 广州 510080

Authors：Chen Binfeng, Zhao Jijun

Unit：Department of Clinical Rheumatology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou 510080, Guangdong, China

摘要：

免疫检查点抑制剂（immune checkpoint inhibitor, ICI）的广泛应用革新了肿瘤治疗范式，但随之而来的免疫相关不良事件（immune-related adverse events, irAEs），尤其是消化系统不良事件，已成为临床实践中亟待解决的重大挑战。本文系统阐述了消化系统irAEs的发病机制，其核心在于ICI诱导的机体自身免疫耐受失衡。该过程涉及由分子模拟与抗原交叉反应、免疫细胞异常激活及肠道微生态紊乱等多因素介导的炎症级联反应。本文详细归纳了ICI治疗过程中上/下消化道、肝胆及胰腺受累的流行病学特征与关键风险因素，并结合最新临床指南，全面梳理了基于不良事件分级的规范化评估与分层管理策略。未来研究应聚焦于深层的免疫学机制挖掘，探索靶向特定免疫细胞亚群、关键信号通路及调节肠道微生态等新型精准干预手段，旨在优化免疫治疗的安全性与有效性。

关键词：免疫检查点抑制剂；免疫相关不良事件；消化系统免疫相关不良事件；不良事件分级

Abstract：

The advent of immune checkpoint inhibitor (ICI) has fundamentally reshaped the paradigm of oncology treatment. However, the emergence of immune-related adverse events (irAEs), particularly digestive system adverse events, presents a formidable clinical challenge. This review systematically elucidates the multifaceted pathogenesis of digestive system irAEs, which primarily stems from the disruption of immunological self-tolerance following ICI therapy. The underlying mechanisms involve complex inflammatory cascades driven by factors such as molecular mimicry and antigen cross-reactivity, dysregulated immune cell activation, and gut microbiota dysbiosis. This article provides a comprehensive overview of the epidemiology and risk factors associated with ICI therapy across the upper/lower gastrointestinal tract, hepatobiliary system, and pancreas. Furthermore, integrated with the latest clinical practice guidelines, this article delineates standardized assessment and stratified management protocols based on severity grading. In conclusion, future research should prioritize decoding the intricate immunological orchestrations of irAEs and exploring precision interventions—including targeting specific immune cell subsets, modulating inflammatory signaling pathways, and leveraging the gut microbiome—to ultimately optimize the therapeutic index of ICI.

Key words：Immune checkpoint inhibitor; Immune-related adverse events; Digestive system adverse events associated with immune checkpoint inhibitor; Adverse event grading

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