卡瑞利珠单抗致免疫相关骨骼肌和心肌损伤

Immune-related skeletal muscle and myocardium injury induced by camrelizumab

1例76岁男性小细胞肺癌患者接受EC(依托泊苷+卡铂)方案化疗联合卡瑞利珠单抗治疗。用药后第22天,患者出现胸闷、气促、呼吸困难、四肢乏力、行走困难等症状。实验室检查示肌酸激酶(CK)1210 U/L,CK-MB 63 U/L。停止化疗和免疫治疗,但患者症状继续加重,实验室检查示肌钙蛋白T(TnT)336 ng/L,CK 1025 U/L,CK-MB 74 U/L,N端脑利钠肽前体(NT-proBNP)648 ng/L;肌肉磁共振及肌电图检查结果示肌肉受损;心脏磁共振检查示左心室心肌纤维化。考虑为卡瑞利珠单抗引起的免疫相关骨骼肌和心肌损伤。予注射用甲泼尼龙琥珀酸钠100 mg静脉滴注、1次/d治疗13 d,患者乏力症状好转,CK及NT-proBNP降至参考值范围,TnT 491 ng/L,CK-MB 113 U/L。加用丙种球蛋白静注人免疫球蛋白20 g静脉滴注、1次/d治疗5 d,患者呼吸困难较前改善,TnT和CK-MB分别降至201 ng/L和59 U/L。

A 76-year-old male patient with small cell lung cancer received EC(etoposide and carboplatin)chemotherapy combined with camrelizumab.On the 22th day of medication,the patient developed chest tightness,shortness of breath,dyspnea,limb weakness,walking difficulty,etc.Laboratory tests revealed creatine kinase(CK)1210 U/L and CK-MB 63 U/L.The chemotherapy and immunotherapy were stopped,but the patient′s symptoms continued to worsen.Laboratory tests showed troponin T(TnT)336 ng/L,CK 1025 U/L,CK-MB 74 U/L,and N-terminal pro brain natriuretic peptide(NT-proBNP)648 ng/L.The muscle magnetic resonance imaging(MRI)and electromyogram showed muscle injury and cardiac MRI showed left ventricular fibrosis.Then immune-related skeletal muscle and myocardial injury caused by camrelizumab was considered.The patient received an IV infusion of methylprednisolone sodium succinate for injection 100 mg once daily for 13 days.Then the patient′s fatigue symptoms were improved,the levels of CK and NT-proBNP decreased to the reference range,but the levels of TnT and CK-MB were 491 ng/L and 113 U/L,respectively.Therefore,an intravenous infusion of immunoglobulin 20 g once daily was given.Five days later,his dyspnea was improved,and TNT and CK-MB decreased to 201 ng/L and 59 U/L,respectively.