大剂量糖皮质激素联合免疫球蛋白治疗PD-1相关重症心肌炎20例

High-Dose Glucocorticoids Combined with Immunoglobulin in the Treatment of 20 Cases of Patients with PD-1-Related Severe Myocarditis

目的观察大剂量糖皮质激素联合免疫球蛋白治疗免疫检查点抑制剂(ICIs)程序性死亡受体1(PD-1)单抗相关的重症心肌炎的近期临床疗效。方法回顾性分析20例采用大剂量糖皮质激素联合免疫球蛋白治疗重症免疫PD-1相关心肌炎患者临床资料。统计和分析患者基线资料、临床症状、心脏生物指标、心脏超声检查指标、既往用药情况等资料。结果20例PD-1相关重症心肌炎患者中19例纳入分析,治疗前左室射血分数(47±6.24)%、峰值肌钙蛋白Ⅰ(2017.37±279.2)pg·mL^(-1)、峰值N末端脑钠肽前体(3892.97±327.03)pg·mL^(-1)。20例患者生存率90.0%,与治疗前比较,患者心脏损伤生物标志物、心脏超声检查指标以及ICIs相关心肌炎分级水平明显好转(P<0.05)。结论大剂量糖皮质激素联合免疫球蛋白治疗可以有效改善PD-1相关重症心肌炎患者心脏功能,提高存活率,为患者提供一种临床有效的用药方案。

Objective To study recent clinical efficacy of high-dose glucocorticoids combined with intravenous immunoglobulin in the treatment of severe myocarditis related to immune checkpoint inhibitor of PD-1 monoclonal antibody.Methods Retrospective analysis of clinical data for 20 patients with severe PD-1-related myocarditis treated with high-dose glucocorticoids and intravenous immunoglobulin.Patient baseline data,clinical symptoms,cardiac biomarkers,cardiac ultrasound indicators,and previous medication history were collected.Results A total of 20 patients with PD-1-related severe myocarditis were observed,and 19 patients were included in the analysis.Before treatment,LVEF was(47±6.24)%,peak cTnI was(2017.37±279.2)pg·mL^(-1),and peak NT-proBNP was(3892.97±327.03)pg·mL^(-1).The survival rate was 90.0%.There was a significant improvement in cardiac injury biomarkers,cardiac ultrasound indicators,and ICIs-related myocarditis grading levels in the patients after the combined treatment(P<0.05).Conclusion High-dose glucocorticoids combined with immunoglobulin therapy can effectively improve cardiac function and increase survival rate in patients with PD-1-related severe myocarditis,providing patients with a clinically effective medication plan.Further studies are needed to explore more treatment options to optimize therapeutic outcomes.