免疫检查点抑制剂致心肌炎合并肌炎和(或)重症肌无力重叠综合征老年患者的临床特征  

Clinical characteristics of elderly patients with immune checkpoint inhibitor-induced myocarditis overlapping with myositis and/or myasthenia gravis syndrome

作　　者：王红梅 韦美华 雷轩 刘岩 刘志峰 文力 WANG Hongmei;WEI Meihua;LEI Xuan;LIU Yan;LIU Zhifeng;WEN Li(Department of Emergency Medicine,the First People's Hospital of Dongcheng District,Beijing 100010,China;Department of General Medicine,Beijing Jingxin Hospital,Beijing 100023,China;Department of Emergency Medicine,Beijing Chest Hospital,Capital Medical University/Beijing Tuberculosis and Thoracic Tumor Research Institute,Beijing 101149,China)

机构地区：[1]北京市东城区第一人民医院急诊科,北京100010 [2]北京京信医院综合内科,北京100023 [3]首都医科大学附属北京胸科医院、北京市结核病胸部肿瘤研究所急诊科,北京101149

出　　处：《临床药物治疗杂志》2025年第3期33-37,共5页Clinical Medication Journal

摘　　要：目的分析免疫检查点抑制剂致心肌炎合并肌炎和(或)重症肌无力重叠综合征(IM3OS)老年患者的临床特征。方法回顾性分析首都医科大学附属北京胸科医院、北京东城区第一人民医院及北京京信医院2021年6月至2024年6月内老年(≥65岁)免疫检查点抑制剂(ICI)相关IM3OS的病例,观察该类患者的临床特征、治疗方案及预后等,分析其发病特点、治疗反应及影响因素。结果共纳入老年IM3OS患者6例。免疫相关不良事件(irAE)平均发生时间为(82.3±37.1)d,初诊时以心血管症状为主,后期逐渐显现出重症肌无力(MG)和肌炎的明显症状。患者心肌酶谱普遍升高,但肌酸激酶(CK)水平和抗乙酰胆碱受体(AchR)抗体阳性率较低。入组6例患者中5例死亡。结论老年IM3OS患者的irAE起病较晚,多以心血管系统表现,临床表现重且治疗效果差。建议更加细致和全面地评估和监测,并提供个体化的治疗方案。Objective To analyze the clinical characteristics of elderly patients with immune checkpoint inhibitor(ICI)-induced myocarditis overlapping with myositis and/or myasthenia gravis(IM3OS).Methods A retrospective analysis was conducted on cases of IM3OS related to ICIs in elderly patients(≥65 years old)from June 2021 to June 2024 at Beijing Chest Hospital affiliated to Capital Medical University,Beijing Dongcheng First People's Hospital,and Beijing Jingxin Hospital.The clinical features,treatment regimens,and prognoses of elderly IM3OS patients were observed,and the onset characteristics,treatment responses,and influencing factors were analyzed.Results A total of six elderly patients with IM3OS were included.The mean time to onset of immune-related adverse events(irAEs)was(82.3±37.1)days.Cardiovascular symptoms predominated at initial diagnosis,with subsequent emergence of prominent symptoms of myasthenia gravis(MG)and myositis.Myocardial enzyme levels were generally elevated,but creatine kinase(CK)levels and positive rates of anti-acetylcholine receptor(AchR)antibodies were relatively low.Treatment regimens primarily included immunosuppressants such as corticosteroids,intravenous immunoglobulin(IVIG),and pyridostigmine,as well as supportive measures like ventilation and plasma exchange.Conclusion The diagnosis of irAEs in elderly IM3OS patients is challenging,with suboptimal treatment outcomes and poor prognoses.More detailed and comprehensive assessment and monitoring are recommended,along with individualized treatment plans.

关 键 词：免疫检查点抑制剂 免疫相关不良事件 心肌炎合并肌炎和(或)重症肌无力重叠综合征 

分 类 号：R979.1[医药卫生—药品] R542.21[医药卫生—药学]