无症状性免疫检查点抑制剂相关性心肌炎:案例及文献回顾  

Asymptomatic Immune Checkpoint Inhibitor-associated Myocarditis:Case Report and Literature Review

作　　者：杨丽瑶 王娟[1] 李敏[1] 张瑶[1] 彭美玲 陈易超 段华新[1] 范莎莎[1] YANG Li-yao;WANG Juan;LI Min;ZHANG Yao;PENG Mei-ling;CHEN Yi-chao;DUAN Hua-xing;FAN Sha-sha(Department of Oncology,Hunan Provincial People’s Hospital,The First Affiliated Hospital of Hunan Normal University,Changsha 410000,China;Department of Oncology,Liuzhou People’s Hospital,Liuzhou 545000,China;Department of Oncology,Changsha County People’s Hospital(Xingsha Campus of Hunan Provincial People’s Hospital),Changsha 410100,China)

机构地区：[1]湖南省人民医院(湖南师范大学附属第一医院)肿瘤科,中国长沙410000 [2]柳州市人民医院肿瘤科,中国柳州545000 [3]长沙县人民医院(湖南省人民医院星沙院区)肿瘤科,中国长沙410100

出　　处：《湖南师范大学自然科学学报》2023年第3期126-133,共8页Journal of Natural Science of Hunan Normal University

基　　金：湖南省卫生健康委员会基金项目(20201859)。

摘　　要：免疫检查点抑制剂(immune checkpoint inhibitor,ICI)一方面提高了肿瘤患者的总生存时间及无进展生存期,另一方面也出现了一系列免疫相关不良反应,在免疫不良反应中ICI相关性心肌炎发病率低,但致死率高。无症状性ICI相关性心肌炎因为其发病隐匿,临床难以发现。本文采用SPSS 27.0统计分析本科室2例病例及在Pubmed和中国知网检索到的9例无症状性ICI相关性心肌炎病例,结果表明:无症状性ICI相关性心肌炎患者在ICI相关性心肌炎患者中,男性、高龄是其高危因素;合并基础心血管疾病及其他免疫相关性疾病的患者病情进展更快,临床症状更重;肌钙蛋白及CK-MB和CK指标在早期诊断中具有重要价值;早期足量激素治疗有利于疾病的控制,降低死亡率,然后再重启免疫治疗可能是安全有效的。In recent years,immune checkpoint inhibitor(ICI) has improved the overall survival(OS) rate and the progression-free survival(PFS) of tumour patients on the one hand,but on the other hand,a series of immune-related adverse event(irAE) has also emerged.Among the immune adverse events,ICI-related myocarditis has a low incidence but a high mortality rate.Asymptomatic patients with ICI-associated myocarditis are difficult to be detected clinically because of its insidious onset.In this paper,nine cases of asymptomatic ICI-associated myocarditis combined with two reported patients were searched through Pubmed and China Knowledge Network,and the statistical analysis was performed using SPSS version 27.0.The results showed that the male and old age were the high risk factors of asymptomatic ICI-associated myocarditis.Patients with basic cardiovascular diseases and other immune-related diseases had faster progresses and severe clinical symptoms.Troponin,CK-MB and CK had great value for early diagnosis.Early and sufficient hormone treatment was conducive to disease control and reducing mortality.Restarting immunotherapy was probably safe and effective.

关 键 词：免疫检查点抑制剂 心肌炎 心脏毒性 无症状性心肌炎 

分 类 号：R969.3[医药卫生—药理学]