联合应用纳武单抗与伊匹木单抗致免疫相关性心肌炎

Immune‑related myocarditis due to combination use of nivolumab and ipilimumab

1例63岁男性患者因膀胱癌肺转移接受纳武单抗(1 mg/kg)和伊匹木单抗(3 mg/kg)静脉滴注,1次/21 d。第2次用药后第3天,患者出现发作性胸闷,平卧数分钟后可自行缓解,实验室检查示超敏肌钙蛋白Ⅰ4340 ng/L,肌酸激酶(CK)⁃MB 98.9μg/L。考虑为纳武单抗和伊匹木单抗所致免疫相关性心肌炎。经甲泼尼龙序贯泼尼松治疗以及补液、保肝护胃、改善心肌代谢、降低氧耗等对症支持治疗后,患者症状明显好转,复查超敏肌钙蛋白Ⅰ192 ng/L,CK⁃MB 28.4μg/L。

A 63⁃year⁃old male patient with lung metastases from bladder cancer received IV infu⁃sions of nivolumab(1 mg/kg)and ipilimumab(3 mg/kg)once every 21 d.On day 3 after the second medica⁃tion,the patient developed paroxysmal chest tightness,which could be self⁃mitigated by lying down for several minutes.Laboratory tests showed high⁃sensitive troponinⅠ4340 ng/L and creatine kinase(CK)⁃MB 98.9μg/L.Immune⁃related myocarditis due to combination use of nivolumab and ipilimumab was considered.After methylprednisolone with prednisone sequentially and symptomatic and supportive treat⁃ments such as fluid infusion,liver and stomach protection,improvement of myocardial metabolism,and reduction of oxygen consumption,the patient′s symptoms were improved obviously.Laboratory tests showed high-sensitive troponinⅠ192 ng/L and CK⁃MB 28.4μg/L.