斯鲁利单抗致免疫性心肌炎伴肌炎和重症肌无力重叠综合征  

Immune-related myocarditis with myositis and myasthenia gravis overlap syndrome induced by serplulimab

作　　者：刘淑娟 蔡伟[2] 袁斌斌[2] 李新[2] 邵凤 Liu Shujuan;Cai Wei;Yuan Binbin;Li Xin;Shao Feng(Department of Pharmacy,Nanjing Medical University Affiliated Benq Medical Center,Nanjing 210019,China;Department of Internal Medicine-Cardiovascular,Nanjing Medical University Affiliated Benq Medical Center,Nanjing 210019,China;PhaseⅠClinical Trial Laboratory,First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)

机构地区：[1]南京医科大学附属明基医院药学部,南京210019 [2]南京医科大学附属明基医院心血管内科,南京210019 [3]南京医科大学第一附属医院Ⅰ期临床试验室,南京210029

出　　处：《药物不良反应杂志》2025年第2期126-128,共3页Adverse Drug Reactions Journal

基　　金：江苏省老年健康科研项目(LKM2023029)。

摘　　要：1例70岁女性胰腺颈体部癌患者接受紫杉醇+吉西他滨化疗11个疗程,因疾病进展接受化疗(氟尿嘧啶+亚叶酸钙+伊立替康)联合免疫治疗(斯鲁利单抗)。28 d后(免疫治疗共1次),患者出现右侧上睑下垂和胸闷症状,继而出现胸骨后中下段疼痛伴咽喉部放射痛,伴构音障碍、吞咽困难、胸闷气喘等症状。实验室检查示高敏肌钙蛋白T 0.551 μg/L,肌酸激酶(CK)3 426 U/L,CK-MB 176 μg/L,肌红蛋白1 702 μg/L。头颈部影像学检查排除颅内病变,心电图检查提示心肌损害。考虑为斯鲁利单抗导致的免疫性心肌炎伴肌炎和重症肌无力重叠综合征。暂缓免疫治疗,予甲泼尼龙、人免疫球蛋白等治疗。治疗免疫性16 d后,患者临床症状缓解,实验室检查示高敏肌钙蛋白I 0.075 μg/L,CK 216 U/L,CK-MB 58 μg/L,肌红蛋白273 μg/L。随访得知,患者改用伊立替康单药或联合雷替曲塞抗肿瘤,未再出现临床症状,心肌损伤标志物、肌酶等均未见异常。A 70-year-old female patient with tumor in the neck and body of the pancreas received 11 cycles of chemotherapy with paclitaxel and gemcitabine.Due to disease progression,she subsequently underwent chemotherapy of fluorouracil,calcium folinate,and irinotecan,combined with immunotherapy of serplulimab.After 28 days(only one session of immunotherapy),the patient developed drooping of the right upper eyelid and chest tightness,followed by pain in the middle and lower segments of the sternum and radiating pain to the throat,accompanied by speech difficulties,dysphagia,and chest tightness and wheezing.Laboratory tests indicated hypersensitive troponin T 0.551μg/L,creatine kinase(CK)3426 U/L,CK-MB 176μg/L,and myoglobin 1702μg/L.The imaging examination of head and neck ruled out intracranial lesions,while the electrocardiogram suggested myocardial damage.Immune-related myocarditis with myositis and/or myasthenia gravis overlap syndrome(IM3OS)induced by serplulimab was considered.Immunotherapy was temporarily halted,and treatments with methyprednisolone and human immunoglobulin were administered.Sixteen days later,clinical symptoms of IM3OS in the patient were improved,with laboratory tests showing hypersensitive troponin I 0.075μg/L,CK 216 U/L,CK-MB 58μg/L,and myoglobin 273μg/L.Upon follow-up,the patient switched to monotherapy with irinotecan alone or combined with raltitrexed for cancer treatment,clinical symptoms of IM3OS did not recur,and no abnormalities were observed in myocardial injury markers or muscle enzymes.

关 键 词：心肌炎 重症肌无力 肌炎 免疫检查点抑制剂 斯鲁利单抗 免疫相关不良事件 

分 类 号：R969[医药卫生—药理学]