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倪美鑫，E-mail：
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Management of immunotherapy-related toxicities version 3. 2021[EB/OL]. （2021-05-14） [2023-06-02] . https://www.nccn.org/guidelines/guidelines-detail?category=3&id=1486., articleTitle=Management of immunotherapy-related toxicities version 3. 2021, refAbstract=null), Reference(id=1239268430226968802, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1239268423495111603, doi=null, pmid=null, pmcid=null, year=2019, volume=66, issue=7, pageStart=581, pageEnd=586, url=null, language=null, rfNumber=[17], rfOrder=17, authorNames=ARIMA H, IWAMA S, INABA H, journalName=Endocr J, refType=null, unstructuredReference=ARIMA H, IWAMA S, INABA H, et al. Management of immune-related adverse events in endocrine organs induced by immune checkpoint inhibitors: clinical guidelines of the Japan Endocrine Society [J]. 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日期血糖/mmol·L-1糖化血红蛋白尿酮体尿葡萄糖胰岛素治疗
早中晚
第一次住院
7月31日52.420.2胰岛素，4 IU·h-1 civ；门冬胰岛素30，16 IU qn sc
8月1日6.414.1~16.39.0-++++门冬胰岛素30，早晚各16 IU sc，余同上
8月2日9.211.2~19.918.4同上
8月3日12.813.6~29.119.9地特胰岛素，8 IU qn sc，余同上
8月4日5.611.5~16.811.68.80%同上
8月5日14.411.6~15.48.9地特胰岛素，14 IU qn sc，余同上
8月6日7.29.8~10.311.3门冬胰岛素30，早18 IU sc、中6 IU sc、晚18 IU sc，余同上
8月7日5.14.9~8.89.8同上
8月8日4.58.5~16.59.0同上
8月9日15.57.3~17.37.7门冬胰岛素30，4 IU qd sc，余同上
8月10日4.78.5~19.36.2同上
8月11日9.37.2~11.68.8同上
第二次住院
9月28日32.8++++++胰岛素，2 IU·h-1 civ；门冬胰岛素30，早、中、晚各8 IU sc；地特胰岛素，10 IU qn sc
9月29日13.326.6同上
9月30日27.025.218.8同上
10月1日21.031.225.6胰岛素，4 IU·h-1 civ；门冬胰岛素30，早12 IU sc、中8 IU sc、晚8 IU sc；地特胰岛素，8 IU qn sc
10月2日14.016.720.5胰岛素，2 IU·h-1，civ，余同上
10月3日13.5出院
), ArticleFig(id=1239268427903324301, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1239268423495111603, language=CN, label=表1, caption=

病例1的血糖等检查指标及胰岛素治疗

, figureFileSmall=null, figureFileBig=null, tableContent=
日期血糖/mmol·L-1糖化血红蛋白尿酮体尿葡萄糖胰岛素治疗
早中晚
第一次住院
7月31日52.420.2胰岛素，4 IU·h-1 civ；门冬胰岛素30，16 IU qn sc
8月1日6.414.1~16.39.0-++++门冬胰岛素30，早晚各16 IU sc，余同上
8月2日9.211.2~19.918.4同上
8月3日12.813.6~29.119.9地特胰岛素，8 IU qn sc，余同上
8月4日5.611.5~16.811.68.80%同上
8月5日14.411.6~15.48.9地特胰岛素，14 IU qn sc，余同上
8月6日7.29.8~10.311.3门冬胰岛素30，早18 IU sc、中6 IU sc、晚18 IU sc，余同上
8月7日5.14.9~8.89.8同上
8月8日4.58.5~16.59.0同上
8月9日15.57.3~17.37.7门冬胰岛素30，4 IU qd sc，余同上
8月10日4.78.5~19.36.2同上
8月11日9.37.2~11.68.8同上
第二次住院
9月28日32.8++++++胰岛素，2 IU·h-1 civ；门冬胰岛素30，早、中、晚各8 IU sc；地特胰岛素，10 IU qn sc
9月29日13.326.6同上
9月30日27.025.218.8同上
10月1日21.031.225.6胰岛素，4 IU·h-1 civ；门冬胰岛素30，早12 IU sc、中8 IU sc、晚8 IU sc；地特胰岛素，8 IU qn sc
10月2日14.016.720.5胰岛素，2 IU·h-1，civ，余同上
10月3日13.5出院
), ArticleFig(id=1239268428016570513, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1239268423495111603, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
日期血糖/mmol·L-1血淀粉酶/U·L-1相关治疗
早中晚
11月10日37.216.619.8胰岛素，10 IU st sc；4.8 IU·h-1 civ，持续16 h
11月11日17.714.912.3胰岛素，10 IU午餐前st sc；门冬胰岛素，10 IU tid sc
11月12日13.611.27.849门冬胰岛素30，基础量0.5 IU·h-1，持续皮下泵入；三餐前8 IU sc
11月13日11.113.312.1门冬胰岛素30，三餐前10 IU sc，余同上
11月15日13.722.016.7甲泼尼龙80 mg qd ivgtt；门冬胰岛素30，三餐前12 IU sc，余同上
11月16日15.916.719.8门冬胰岛素30，三餐前16 IU sc，余同上
11月17日18.616.015.2达格列净10 mg qd po；门冬胰岛素30，三餐前18 IU sc，余同上
11月18日6.812.214.4甲泼尼龙40 mg qd ivgtt；门冬胰岛素30，三餐前12 IU sc，余同上
11月22日9.917.419.3停门冬胰岛素；门冬胰岛素30，早晚餐前24 IU sc、中餐前8 IU sc，余同上
11月24日4.53.615.5甲泼尼龙20 mg qd ivgtt；门冬胰岛素30，20 IU bid sc，余同上
11月25日7.4门冬胰岛素30，16 IU bid sc，带药出院
), ArticleFig(id=1239268428104650900, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1239268423495111603, language=CN, label=表2, caption=

病例2的血糖等检查指标及相关治疗

, figureFileSmall=null, figureFileBig=null, tableContent=
日期血糖/mmol·L-1血淀粉酶/U·L-1相关治疗
早中晚
11月10日37.216.619.8胰岛素，10 IU st sc；4.8 IU·h-1 civ，持续16 h
11月11日17.714.912.3胰岛素，10 IU午餐前st sc；门冬胰岛素，10 IU tid sc
11月12日13.611.27.849门冬胰岛素30，基础量0.5 IU·h-1，持续皮下泵入；三餐前8 IU sc
11月13日11.113.312.1门冬胰岛素30，三餐前10 IU sc，余同上
11月15日13.722.016.7甲泼尼龙80 mg qd ivgtt；门冬胰岛素30，三餐前12 IU sc，余同上
11月16日15.916.719.8门冬胰岛素30，三餐前16 IU sc，余同上
11月17日18.616.015.2达格列净10 mg qd po；门冬胰岛素30，三餐前18 IU sc，余同上
11月18日6.812.214.4甲泼尼龙40 mg qd ivgtt；门冬胰岛素30，三餐前12 IU sc，余同上
11月22日9.917.419.3停门冬胰岛素；门冬胰岛素30，早晚餐前24 IU sc、中餐前8 IU sc，余同上
11月24日4.53.615.5甲泼尼龙20 mg qd ivgtt；门冬胰岛素30，20 IU bid sc，余同上
11月25日7.4门冬胰岛素30，16 IU bid sc，带药出院
), ArticleFig(id=1239268428201119895, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1239268423495111603, language=EN, label=null, caption=null, figureFileSmall=null, figureFileBig=null, tableContent=
评分项目病例1病例2
是否未知是否未知
该ADR先前是否有结论性报告？11
该ADR是否在使用可疑药物后发生？22
该ADR是否在停药或使用拮抗剂后有缓解？11
该ADR是否在再次使用可疑药物后重复出现？20
是否存在其他因素能单独引起该ADR？22
该ADR是否在使用安慰剂后重复出现？00
药物在血液或其他体液中是否达到毒性浓度？00
该ADR是否随剂量增加而加重，或随剂量减少而缓解？00
患者是否曾暴露于同种或同类药物并出现过类似反应？00
是否存在任何客观证据证实该ADR？11
总得分97
), ArticleFig(id=1239268428289200284, tenantId=1146029695717560320, journalId=1205117082300743687, articleId=1239268423495111603, language=CN, label=表3, caption=

诺氏（Naranjo’s）药物不良反应评估结果

, figureFileSmall=null, figureFileBig=null, tableContent=
评分项目病例1病例2
是否未知是否未知
该ADR先前是否有结论性报告？11
该ADR是否在使用可疑药物后发生？22
该ADR是否在停药或使用拮抗剂后有缓解？11
该ADR是否在再次使用可疑药物后重复出现？20
是否存在其他因素能单独引起该ADR？22
该ADR是否在使用安慰剂后重复出现？00
药物在血液或其他体液中是否达到毒性浓度？00
该ADR是否随剂量增加而加重，或随剂量减少而缓解？00
患者是否曾暴露于同种或同类药物并出现过类似反应？00
是否存在任何客观证据证实该ADR？11
总得分97
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替雷利珠单抗致免疫相关糖尿病合并酮症酸中毒2例
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梅丹 a , 龚军 b , 王慧芳 a , 倪美鑫 a
中国新药与临床杂志 | 药物警戒 2024,43(7): 556-560
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中国新药与临床杂志 | 药物警戒 2024, 43(7): 556-560
替雷利珠单抗致免疫相关糖尿病合并酮症酸中毒2例
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梅丹a , 龚军b, 王慧芳a, 倪美鑫a
作者信息
  • a.南通大学附属肿瘤医院 药剂科，江苏 南通　226361
  • b.南通大学附属肿瘤医院 肿瘤内科，江苏 南通　226361

    • 梅丹，女，副主任药师，硕士，主要从事抗肿瘤药物临床药学研究，E-mail：

通讯作者:

倪美鑫，E-mail：
Two cases of immune-related diabetic ketoacidosis induced by tislelizumab
Dan MEIa , Jun GONGb, Hui-fang WANGa, Mei-xin NIa
Affiliations
  • a.Department of Pharmacy, Affiliated Tumor Hospital of Nantong University, Nantong JIANGSU 226361, China
  • b.Department of Medical Oncology, Affiliated Tumor Hospital of Nantong University, Nantong JIANGSU 226361, China
出版时间: 2024-07-25 doi: 10.14109/j.cnki.xyylc.2024.07.14
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替雷利珠单抗  /  糖尿病  /  糖尿病酮症酸中毒  /  程序性细胞死亡受体1  /  药物不良反应
tislelizumab  /  diabetes mellitus  /  diabetic ketoacidosis  /  programmed cell death 1 receptor  /  adverse drug reactions
梅丹, 龚军, 王慧芳, 倪美鑫. 替雷利珠单抗致免疫相关糖尿病合并酮症酸中毒2例. 中国新药与临床杂志, 2024 , 43 (7) : 556 -560 . DOI: 10.14109/j.cnki.xyylc.2024.07.14
Dan MEI, Jun GONG, Hui-fang WANG, Mei-xin NI. Two cases of immune-related diabetic ketoacidosis induced by tislelizumab[J]. Chinese Journal of New Drugs and Clinical Remedies, 2024 , 43 (7) : 556 -560 . DOI: 10.14109/j.cnki.xyylc.2024.07.14
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替雷利珠单抗是由我国自主研发的一种新型人源化IgG4型单克隆抗体，具有区别于其他程序性细胞死亡受体1（programmed cell death 1 receptor，PD-1）免疫检查点抑制剂（immune checkpoint inhibitors，ICIs）的特有结合表位，其Fc段经改造后可以有效避免抗体依赖的细胞吞噬作用，减少了T细胞损耗，从而更好地发挥抗肿瘤活性[1]。替雷利珠单抗与PD-1的解离速率比纳武利尤单抗、帕博利珠单抗的解离速率慢，因此其靶向亲和力比这两种PD-1抑制剂高35~60倍[2]。替雷利珠单抗于2019年12月首次获国家药品监督管理局批准用于治疗经典型霍奇金淋巴瘤患者，近几年相继获批用于尿路上皮癌、非小细胞肺癌、肝细胞癌等疾病的治疗，给多癌种患者带来了临床获益。但该药使用后亦可能出现免疫相关不良反应，其中发生率超过1%的包括免疫相关性甲状腺功能减退，免疫相关性皮肤不良反应，免疫相关性肝炎、肺炎、结肠炎等。然而，替雷利珠单抗导致免疫相关糖尿病较为罕见，仅见Cancer Science上的一篇临床研究[3]提及使用替雷利珠单抗后出现了2例轻度1型糖尿病，但仅简单提及相关数据，无病例具体情况。现分析贲门癌和肺癌各1例患者使用替雷利珠单抗后出现严重免疫相关糖尿病经治疗好转的病例，探讨替雷利珠单抗致免疫相关糖尿病的特点和治疗措施，以期为该罕见免疫相关不良反应的防治提供参考。
病例1，男，73岁，身高165 cm，体重58 kg。2020年6月19日、7月11日分别予替雷利珠单抗200 mg d1免疫治疗2周期，6月22日、7月13日予曲妥珠单抗（首次520 mg，其次390 mg）靶向治疗2周期。7月31日该患者入院，头晕伴乏力、口干、多饮和多尿，进食稍不畅，半流质饮食。患者有慢性肾功能不全病史3年、原发性高血压病史20余年，未规律服药与治疗。否认糖尿病等其他病史，否认食物、药物过敏史。入院诊断为“贲门恶性肿瘤，慢性肾功能不全，双侧脑室腔隙性梗塞，原发性高血压”。入院检查示血糖52.4 mmol·L-1，肌酐248 μmol·L-1，尿酸442 μmol·L-1，血淀粉酶66 U·L-1，立即予I级护理、胰岛素注射液4 IU·h-1持续静脉泵入、监测末梢血糖q2h、心电监护。当晚20∶20血糖20.2 mmol·L-1，头晕症状较前明显好转。8月7日予曲妥珠单抗390 mg，8月10日予替雷利珠单抗200 mg治疗。8月12日准予出院，出院带药地特胰岛素注射液、门冬胰岛素30注射液。9月3日予曲妥珠单抗390 mg，静滴。9月28日该患者至本院门诊就诊，诉口干伴乏力，查血糖32.8 mmol·L-1，血钾6.4 mmol·L-1，尿常规：酮体（++），尿葡萄糖（++++），心电图示窦性心律，ST-T改变，收治入院。立即予胰岛素降糖、呋塞米排钾利尿、碳酸氢钠碱化尿液等治疗。患者两次住院期间的血糖等相关检查指标及胰岛素治疗情况见表1。患者血糖控制欠佳，于10月3日出院，转至综合医院安装胰岛素皮下泵，后继续使用曲妥珠单抗390 mg靶向治疗第11周期，未再使用替雷利珠单抗及其他免疫治疗。至2022年8月，患者仍处于生存期。
病例2，男，60岁，身高170 cm，体重61.5 kg。患者于2021年4月8日至7月27日予替雷利珠单抗200 mg d0+紫杉醇（白蛋白结合型）400 mg d1化疗4周期。9月2日、10月6日分别予替雷利珠单抗单药200 mg d1维持治疗。11月10日凌晨患者突发胸闷、气促不适，至本院急诊查血常规示白细胞19.3×109·L-1，中性粒细胞占比0.911；血生化：尿酸792 μmol·L-1，葡萄糖37.2 mmol·L-1。血气分析：pH 7.15，动脉血二氧化碳分压（pCO2）15 mmHg，动脉血氧分压（pO2）137 mmHg。患者20余年前因“左眼外伤”致“左眼失明”，5年前因“右下肺鳞癌”行“右肺中下叶切除术”，术后分期pT2aN0M0 ⅡB期，否认糖尿病等其他病史，否认食物、药物过敏史。入院诊断：酮症酸中毒，左肺上叶鳞癌化疗后（pT3NxM0），右肺下叶鳞癌术后（pT3N0M0）。当日凌晨入院后立即予胰岛素10 IU皮下注射，5%碳酸氢钠250 mL静滴等治疗。患者本次住院期间的血糖等检查指标及相关治疗情况见表2。11月11日该患者胸闷不适较入院时明显好转，无气喘、气急，测空腹血糖17.7 mmol·L-1。尿常规：酮体（+++）、尿蛋白（+）、尿葡萄糖（++++）；血气分析示pH 7.43，pCO2 28 mmHg，pO2 131 mmHg。11月25日患者无胸闷、气喘，测随机血糖5.6 mmol·L-1，门冬胰岛素30调整为16 IU bid，予带泼尼松片、达格列净片出院。2022年2月患者因脑多发转移瘤予全脑姑息放疗，入院前未再予替雷利珠单抗及其他抗肿瘤药物治疗。2022年8月采集患者的生存情况时，发现其已不在生存期。
以上2例患者发生的糖尿病合并酮症酸中毒与替雷利珠单抗的因果关系，以诺氏（Naranjo’s）药物不良反应评估表法进行评价，结果见表3。2例患者均为男性，年龄≥60岁，无糖尿病病史，用药前血糖水平正常，多次住院治疗期间血糖监测均在正常范围内。病例1接受2个疗程替雷利珠单抗（距首次给药6周、末次给药约3周）联合曲妥珠单抗治疗后出现高血糖，随后确诊糖尿病，血糖控制后再次给予替雷利珠单抗治疗，后出现糖尿病合并酮症酸中毒。病例2接受4个疗程含替雷利珠单抗的联合化疗、2个疗程替雷利珠单抗单药维持治疗后（距首次给药约31周、末次给药5周）出现高血糖，并确诊为糖尿病合并酮症酸中毒。2例患者发生糖尿病时间差异较大，但与替雷利珠单抗的使用均有时间相关性，且2例患者合并使用的曲妥珠单抗、紫杉醇（白蛋白结合型）或其他药物均未见致糖尿病或高血糖的相关报道。替雷利珠单抗说明书中“特定不良反应描述”里提及，单药治疗和联合化疗时免疫相关糖尿病或高血糖症发生率分别为0.5%、0.8%，其中4级不良反应发生率分别为<0.1%（1/1 797）、0.2%（1/497）。因此，根据诺氏药物不良反应评估量表[7]，病例1评分为9分，判定该患者发生糖尿病合并酮症酸中毒与使用替雷利珠单抗的因果关系为肯定；病例2评分为7分，判定该患者发生糖尿病合并酮症酸中毒与使用替雷利珠单抗的因果关系为很可能。
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ICIs通过靶向结合细胞毒性T淋巴细胞相关抗原4（CTLA-4）和PD-1及其配体PD-L1，产生了一系列因T细胞组织浸润而导致的毒性反应，被称为免疫相关不良反应[4]。PD-1/PD-L1抑制剂免疫相关糖尿病近两年偶有报道，但仍属于比较罕见的免疫相关不良反应。据报道，ICIs相关糖尿病发生率<1%[5,6]，但一旦发生则常发展为严重的糖尿病酮症酸中毒，对肿瘤患者预后及后续治疗均产生负面影响，甚至危及生命安全。ICIs治疗诱发的免疫相关糖尿病，平均在接受ICIs治疗后8.5周（1~48周）开始出现临床表现，其中75%以糖尿病合并酮症酸中毒起病[8]。一篇纳入了90例使用不同ICIs治疗后出现糖尿病的综述[9]显示，71%的患者存在酮症酸中毒，平均4.5个疗程后确诊糖尿病；若接受不同ICIs联合治疗，则平均在2.7个疗程后确诊，且各种ICIs治疗方案均可能导致早发性糖尿病（即治疗后1~2个疗程确诊）。本文2例患者均存在酮症酸中毒，使用替雷利珠单抗后出现糖尿病的发病时间及相关特点与文献报道的其他ICIs基本一致[3]。2例患者使用同一种ICIs出现糖尿病的时间点差异较大，提示ICIs导致糖尿病出现时间长短与使用药物种类的相关性可能不大，而更有可能与患者的个体差异性相关。不同人群的糖尿病易患性不同，本身存在内分泌功能障碍、PD-L1的单核苷酸多态性rs4143815或rs2297137[10,11]、HLA-DR4-DQ8或HLA-DR3-DQ2等位基因[12]均与糖尿病的易患性之间存在显著相关性。
PD-L1在胰岛细胞上表达，PD-1/PD-L1抑制自身反应性T淋巴细胞的活化，从而对自身免疫性糖尿病有保护作用。阻断PD-1/PD-L1通路，例如使用PD-1/PD-L1抑制剂，解除了对该活化的抑制，使得自身反应性T淋巴细胞异常活化，进而导致胰岛细胞浸润和破坏，这可能是PD-1/PD-L1抑制剂导致糖尿病的主要机制。因此，PD-1/PD-L1抑制剂可直接破坏胰岛β细胞，抑制胰岛素的合成，降低胰岛素分泌甚至加重胰岛素抵抗[13]，其临床表现可能与1型糖尿病相似[14]。但是PD-1/PD-L1抑制剂引起的胰岛功能损伤更为快速和显著，这是PD-1/PD-L1抑制剂导致胰岛β细胞急性丢失的结果，表现为从正常血糖到高血糖水平的快速转变，大多数患者甚至发展为酮症酸中毒。
根据《中国临床肿瘤学会（CSCO）免疫检查点抑制剂相关的毒性管理指南（2021）》[15]，ICIs导致的高血糖或糖尿病根据空腹血糖水平分为G1~G4级，空腹血糖水平>27.2 mmol·L-1为4级不良反应。根据不同分级的高血糖/糖尿病以及酮症酸中毒检查结果，给予相应的处理措施，酮症酸中毒检查阴性继续ICIs治疗，酮症酸中毒检查阳性则暂停ICIs治疗，并实施酮症酸中毒管理，其中最主要的治疗措施是持续输注胰岛素以控制血糖，并及时给予补液、纠正酸中毒，调节水电解质平衡等。ICIs致免疫相关糖尿病合并酮症酸中毒，经积极治疗后能否重启免疫治疗？针对这一问题，包括美国国立综合癌症网络（NCCN）免疫治疗相关毒性管理指南在内的多项指南均指出，免疫相关糖尿病的发生不代表永久停用免疫治疗方案[16]。本文2例患者入院空腹血糖远超27.2 mmol·L-1，均为4级不良反应。其中，病例1首次出现免疫相关糖尿病时未继发酮症酸中毒，血糖控制平稳后继续予以替雷利珠单抗免疫治疗1个周期，随后患者血糖控制不佳且出现酮症酸中毒，永久停用替雷利珠单抗；病例2首次出现免疫相关糖尿病合并酮症酸中毒后，立即停用替雷利珠单抗，临床考虑其合并免疫相关性胰腺炎，加用了糖皮质激素治疗后，血糖控制于正常范围。因此，免疫相关糖尿病的发生虽不是重启免疫治疗的禁忌，但重启免疫治疗后免疫相关糖尿病可能会进一步发展并加重，对于出现严重免疫相关糖尿病的患者，临床应尤其谨慎重启免疫治疗。另外，尽管糖皮质激素因为其升高血糖的药理作用而不推荐用于免疫相关糖尿病的治疗[17]，但从病例2的治疗效果来看，若合并其他免疫相关不良反应且单纯依靠胰岛素治疗血糖控制不佳时，糖皮质激素仍是可选的治疗药物之一。
替雷利珠单抗导致的免疫相关糖尿病比较罕见，其发生发展的机制被认为与抗肿瘤机制途径相同，因此免疫治疗想要完全避免糖尿病的发生极为困难。另外，免疫相关糖尿病合并酮症酸中毒的临床表现不具特异性，易与其他的免疫相关不良反应及肿瘤本身症状混淆，所以不易早期识别。本文2例患者出现免疫相关糖尿病时临床表现均无特异性，病例1贲门腺癌患者因合并脑梗死有头晕症状，病例2左肺鳞癌患者出现胸闷、气急，均可能是患者原发疾病所导致，不易识别。因此，血糖监测应列入接受替雷利珠单抗等免疫治疗的长期随访监测计划，用药期间甚至停药后一段时间内仍需密切监测血糖水平。做好患者用药教育，优化免疫相关不良反应管理策略，同时寻求可筛查高危人群的预测指标，是今后肿瘤免疫治疗临床实践的努力方向之一。
基金
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  • 南通市卫健委科研课题(QN2022032)
  • 江苏省药学会-奥赛康医院药学科研基金项目(A202331)
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参考文献 引证文献
排序方式：
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2024年第43卷第7期
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doi: 10.14109/j.cnki.xyylc.2024.07.14
  • 接收时间：2022-04-29
  • 首发时间：2026-03-13
  • 出版时间：2024-07-25
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  • 收稿日期：2022-04-29
  • 录用日期：2024-06-17
基金
南通市卫健委科研课题(QN2022032)
江苏省药学会-奥赛康医院药学科研基金项目(A202331)
作者信息
    a.南通大学附属肿瘤医院 药剂科，江苏 南通　226361
    b.南通大学附属肿瘤医院 肿瘤内科，江苏 南通　226361

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species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
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Percentage of total
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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
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