程序性死亡受体1抑制剂致免疫相关性心肌炎的临床特征分析  

Clinical characteristics analysis of immune-related myocarditis induced by PD-1 inhibitor

作　　者：廖音[1] 程晟[1] 李新刚 LIAO Yin;CHENG Sheng;LI Xingang(Department of Pharmacy,Beijing Friendship Hospital Affiliated to Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京友谊医院药剂科,北京100050

出　　处：《临床药物治疗杂志》2024年第7期64-68,共5页Clinical Medication Journal

基　　金：白求恩·求索-药学科研能力建设项目(2022-2-23)。

摘　　要：目的探讨PD-1抑制剂致免疫相关性心肌炎的临床特征及药学监护策略。方法回顾性分析2020—2023年首都医科大学附属北京友谊医院收治的PD-1抑制剂致免疫相关性心肌炎病例的诊疗过程,分析患者的临床特征、治疗及转归情况。结果共纳入5例患者,其中使用替雷利珠单抗2例、信迪利单抗1例、卡瑞利珠单抗1例、特瑞普利单抗1例。从首次使用PD-1抑制剂治疗至确诊为免疫相关性心肌炎时间为(36.80±12.74)d。5例患者心肌酶谱均明显升高,均给予糖皮质激素治疗。治疗后,1例患者症状完全好转,4例死亡。结论免疫相关性心肌炎是PD-1抑制剂的罕见严重不良反应,死亡率高,医师和药师须加强监护以尽早发现并干预,糖皮质激素治疗应给予合适剂量、疗程及患者教育,以增加患者的用药安全。Objective To investigate the clinical characteristics and pharmaceutical care strategy of immune-related myocarditis induced by PD-1 inhibitor.Methods The diagnosis and treatment process of PD-1 inhibitor-induced immune-related myocarditis treated in Beijing Friendship Hospital Affiliated to Capital Medical University from 2020 to 2023 were retrospectively analyzed,and the clinical characteristics,treatment,and outcome of the patients were analyzed.Results A total of five patients were included,among which two cases were treated with tislelizumab,one case with sintilimab,one case with camrelizumab,and one case with toripalimab.The time from the first treatment with PD-1 inhibitor to a diagnosis of immunerelated myocarditis was(36.80±12.74)days.All five cases showed a significant increase in myocardial enzyme spectrum and were treated with glucocorticoids.After treatment,the symptoms of one case were completely improved,and four cases died.Conclusion Immune myocarditis is a rare but severe adverse reaction to PD-1 inhibitors,with a high mortality rate.Physicians and pharmacists should enhance monitoring to detect immune-related myocarditis early.Appropriate dosage,duration of treatment,and patient education during corticosteroid therapy should be provided to enhance medication safety for patients.

关 键 词：程序性死亡受体1抑制剂 免疫检查点抑制剂 免疫相关性心肌炎 药学监护 

分 类 号：R979.1[医药卫生—药品] R969.3[医药卫生—药学]