靶向联合免疫检查点抑制剂治疗对肝细胞癌患者心肌肌钙蛋白T的影响  

Effect of targeted therapy combined with immune checkpoint inhibitors on cardiac troponin T in patients with hepatocellular carcinoma

作　　者：郭新坤 谌小春 郑苏苏 吴燕芳 谢晓莺 张博恒 GUO Xin-kun;CHEN Xiao-chun;ZHENG Su-su;WU Yan-fang;XIE Xiao-ying;ZHANG Bo-heng(Department of Hepatic Oncology,Zhongshan Hospital,Fudan University(Xiamen Branch),Xiamen 361015,Fujian,China;Xiamen Clinical Medical Research Center for Comprehensive Treatment of Malignant Tumor,Xiamen 361015,Fujian,China;Department of Hepatic Oncology,Zhongshan Hospital,Fudan University,Shanghai 200032,China)

机构地区：[1]复旦大学附属中山医院厦门医院肝肿瘤内科,厦门361015 [2]厦门市恶性肿瘤综合治疗临床医学研究中心,厦门361015 [3]复旦大学附属中山医院肝肿瘤内科,上海200032

出　　处：《中国临床医学》2023年第2期272-278,共7页Chinese Journal of Clinical Medicine

基　　金：厦门市科技计划医疗卫生重点项目(3502Z20191105)。

摘　　要：目的探讨肝细胞癌患者靶向联合免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)治疗过程中出现心肌肌钙蛋白T(cTnT)升高的发生率及临床特征。方法收集2017年1月至2021年12月复旦大学附属中山医院厦门医院肝肿瘤内科住院治疗的125例接受靶向联合ICIs治疗的肝细胞癌患者临床资料,根据治疗过程中cTnT水平变化分为cTnT正常组(cTnT<0.03 ng/mL,n=114)和cTnT升高组(cTnT≥0.03 ng/mL,n=11),分析2组患者的基线特征以及cTnT升高组患者cTnT升高前后的临床指标改变。结果肝细胞癌患者靶向联合ICIs治疗过程中cTnT升高发生率为8.8%(11/125),其中心肌炎的发生率为0.8%(1/125)。高龄、糖尿病史、心脏疾病史可能是cTnT升高的危险因素。11例患者cTnT升高后左心室射血分数显著下降(P=0.020),左心室舒张末期内径显著减小(P=0.013),白介素2受体水平显著增加(P=0.038)。结论靶向联合ICIs治疗肝细胞癌可引起患者cTnT升高;监测cTnT变化有助于早期发现心肌损伤,对预防药物相关的心脏不良事件具有重要意义。Objective To explore the incidence and clinical characteristics of cardiac troponin T(cTnT)elevation in patients with hepatocellular carcinoma who received targeted combined with immune checkpoint inhibitors(ICIs)therapy.Methods From January 2017 to December 2021,125 patients with hepatocellular carcinoma treated with targeted combined with ICIs therapy in Zhongshan Hospital,Fudan University(Xiamen Branch)were collected.Patients were divided into cTnT normal group(cTnT<0.03 ng/mL,n=114)and cTnT elevated group(cTnT≥0.03 ng/mL,n=11)according to the changes in cTnT levels during treatment.The baseline characteristics between the two groups,the clinical changes before and after cTnT elevation in cTnT elevated groups were analyzed.Results cTnT elevation occurred in 11 patients(8.8%),including 1 myocarditis(0.8%).Elder age,history of cardiovascular disease,history of diabetes might be risk factors for cTnT elevation.After cTnT elevation,decreased left ventricular ejection fraction(P=0.020),decreased left ventricular end diastolic diameter(P=0.013)and increased interleukin-2 receptor(P=0.038)were found.Conclusions Targeted therapy combined with ICIs could lead to cTnT elevation in some patients with hepatocellular carcinoma.Monitoring cTnT changes is helpful for early detection of myocardial injury and has important implications for the prevention of medication related cardiac adverse events.

关 键 词：肝细胞癌 靶向治疗 免疫检查点抑制剂 心肌肌钙蛋白T 

分 类 号：R735.7[医药卫生—肿瘤]