免疫检查点抑制剂致免疫性心肌炎的88例分析  

Analysis of 88 cases of immune myocarditis due to immune checkpoint inhibitors

作　　者：胡佳佳 葛红星[1] 雷招宝[1] HU Jiajia;GE Hongxing;LEI Zhaobao(Department of Pharmacy,Fengcheng People's Hospital,Jiangxi Fengcheng 331100,China)

机构地区：[1]丰城市人民医院药学部,江西丰城331100

出　　处：《中国医院药学杂志》2024年第23期2784-2788,共5页Chinese Journal of Hospital Pharmacy

摘　　要：目的:分析与探讨免疫检查点抑制剂(immune checkpoint inhibitors,ICIs)致免疫性心肌炎的临床特征、治疗方式、致病机制以及预防措施,为临床安全用药提供参考。方法:检索中国知网、万方医学网和PubMed等数据库,以已上市的ICIs分别与“心肌炎”组合进行检索,下载文献原文,进行回顾性分析。结果:共检索到84篇88例个案报道,报道最多的是帕博利珠单抗,其次是信迪利单抗、卡瑞利珠单抗。年龄(64.44±9.81)岁,以老年患者多见,63例(71.6%)为男性,死亡率为21.6%。临床症状以呼吸困难或呼吸急促最为常见(44.3%,39/88),出现症状时间大多集中在用药1~2周期后(81.8%,72/88),且90%以上患者心脏生物标志物水平升高。84例(95.5%)患者接受糖皮质激素初始治疗,67例(79.8%)患者症状改善。在此基础上,同时使用其他免疫抑制剂、血浆置换、植入心脏起搏器或体外膜氧合方式进行治疗,可进一步改善临床症状。结论:ICIs致免疫性心肌炎以老年男性患者居多,临床症状不具特异性。糖皮质激素治疗有效,免疫抑制剂、血浆置换、植入心脏起搏器或体外膜氧合可能改善临床症状,提高存活率。ICIs致免疫性心肌炎死亡率较高,应引起临床医务工作者的高度关注。OBJECTIVE To explore the clinical features,treatments,pathogenic mechanisms and preventive measures of myocarditis due to immune checkpoint inhibitors(ICIs)and provide reference for clinical safe dosing.METHODS Through searching marketed ICIs in combination with"myocarditis",case reports on immune myocarditis induced by ICIs were retrieved from the databases of China National Knowledge Infrastructure(CNKI),Wanfang and PubMed.RESULTS A total of 84articles and 88 cases were collected.Pembrolizumab was the most commonly reported,followed by sintilimab and camrelizumab.Average age was(64.33±9.84)year and elders predominated.There were 63 males(71.6%)with a mortality rate of 21.6%.The most common clinical symptoms were dyspnea or tachypnea(44.3%,39/88).Most symptoms occurred after 1-2 cycles of medication(81.8%,72/88)and over 90%of them exhibited elevated levels of cardiac biomarkers.Among 84 cases(95.5%)on glucocorticoid therapy,the symptoms of 67 cases(79.8%)improved.And treatments with other immunosuppressants,plasma exchange,implanted pacemaker or extracorporeal membrane oxygenation(ECMO)could further improve clinical symptoms.CONCLUSION ICIS-induced immune myocarditis is predominant in elderly males and clinical symptoms are non-specific.Glucocorticoid therapy is effective.And immunosuppressants,plasma exchange,implanted pacemaker and ECMO may improve clinical symptoms and survival rate.The mortality rate of ICIS-induced immune myocarditis remains high so that clinicians should raise a high alert.

关 键 词：免疫检查点抑制剂 帕博利珠单抗 信迪利单抗 卡瑞利珠单抗 免疫性心肌炎 

分 类 号：R979.5[医药卫生—药品]