免疫检查点抑制剂相关心肌炎与主要不良心血管事件危险因素分析及预测模型的构建  

Analysis of risk factors and establishment of prediction model for immune checkpoint inhibitor related myocarditis and major adverse cardiovascular events

作　　者：陆睿 陆靖 廖祎 罗文洁 王敏[1] 鲁明军[1] Lu Rui;Lu Jing;Liao Yi;Luo Wenjie;Wang Min;Lu Mingjun(Department of Vasculocardiology,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510120,China;Department of Neurology,the First Affiliated Hospital of Hainan Medical University,Haikou 570102,China)

机构地区：[1]广州医科大学附属第一医院心血管内科,广州510120 [2]海南医学院第一附属医院神经内科,海口570102

出　　处：《中华心血管病杂志》2024年第11期1290-1295,共6页Chinese Journal of Cardiology

基　　金：广州市科技局项目(202102010180);广东省援疆科技项目(2017B0202470)。

摘　　要：目的探讨免疫检查点抑制剂相关心肌炎主要不良心血管事件(MACE)的危险因素及预测模型的建立。方法本研究为回顾性病例对照研究。收集2019年5月至2023年8月于广州医科大学第一附属医院确诊为免疫检查点抑制剂相关心肌炎的肿瘤患者,根据是否发生MACE分为无MACE组和MACE组,收集2组患者的一般临床资料及影像学资料。采用单因素和多因素logistic回归模型分析免疫检查点抑制剂相关心肌炎患者发生MACE的危险因素。根据多因素分析结果,采用R 4.1.0软件构建此类患者的MACE风险预测模型并绘制列线图。绘制受试者工作特征曲线,评价预测模型的预测效果。结果共纳入35例免疫检查点抑制剂相关心肌炎患者,年龄(63.9±8.2)岁,其中男性28例(80%)。无MACE组18例,MACE组17例。多因素logistic回归分析显示,中性粒细胞/淋巴细胞比率升高(OR=1.115,95%CI 1.007~1.235,P=0.036)和ST-T段改变(OR=24.942,95%CI 1.239~502.194,P=0.036)是免疫检查点抑制剂相关心肌炎患者发生MACE的危险因素。受试者工作特征曲线提示预测模型的曲线下面积为0.967(95%CI 0.916~1.000,P<0.001),灵敏度为88.2%,特异度为100%,该模型具有良好的预测能力。结论中性粒细胞/淋巴细胞比率升高和ST-T段改变是免疫检查点抑制剂相关心肌炎患者发生MACE的独立危险因素,基于上述两指标构建的风险预测模型可辅助该类患者的早期识别并进行个体化干预。Objectives To explore the risk factors of major adverse cardiovascular events(MACEs)in immune checkpoint inhibitor(ICI)related myocarditis and establish a predictive model.Methods This was a retrospective case-control study.Tumor patients diagnosed with ICI related myocarditis in the First Affiliated Hospital of Guangzhou Medical University from May 2019 to August 2023 were selected and divided into non-MACE group and MACE group based on whether MACE occurred.Clinical and imaging data of the two groups were collected.Univariate and multivariate logistic regression models were used to analyze the risk factors for MACE in patients with ICI related myocarditis.According to the results of multivariate logistic regression analysis,R 4.1.0 software was used to construct the MACE risk prediction model for these patients and draw a nomogram.The receiver operating characteristic curve was used to evaluate the prediction ability of the prediction model.Results A total of 35 patients with ICI related myocarditis,aged(63.9±8.2)years,were included,including 28 males(80%).There were 18 patients in the non-MACE group and 17 patients in the MACE group.Multivariate logistic regression analysis showed that elevated neutrophil to lymphocyte ratio(OR=1.115,95%CI 1.007-1.235,P=0.036)and ST-T segment changes(OR=24.942,95%CI 1.239-502.194,P=0.036)were risk factors for MACE in patients with ICI related myocarditis.The receiver operating characteristic curve indicated that the area under the curve of the prediction model was 0.967(95%CI 0.916-1.000,P<0.001),with a sensitivity of 88.2%and specificity of 100%,demonstrating good predictive ability.Conclusion Elevated neutrophil to lymphocyte ratio and ST-T segment change are independent risk factors for MACE in patients with ICI related myocarditis.Risk prediction model based on the above two indicators can assist in the early identification and individualized intervention of ICI related myocarditis patients.

关 键 词：心肌炎 免疫检查点抑制剂 主要不良心血管事件 危险因素 列线图 预测模型 

分 类 号：R542.2[医药卫生—心血管疾病]