免疫检查点抑制剂治疗老年肿瘤患者肺静脉血流分析

Analysis of pulmonary venous flow in elderly tumor patients treated with immune checkpoint inhibitors

目的 分析免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)治疗老年恶性肿瘤患者的肺静脉血流(pulmonary venous flow, PVF)频谱特点,并探讨PVF在免疫相关性心肌损害中的价值。方法 选取复旦大学附属金山医院肿瘤科2020年8月—2023年3月收治的年龄≥65岁且接受ICIs治疗的25例恶性肿瘤患者作为研究对象,另选取性别、年龄匹配的24例正常人作为对照组。利用超声心动图测量PVF-S波、D波、Ar波峰值流速,病例组治疗前、后常规查心肌酶谱及心电图,以肌钙蛋白I(troponin I,TnI)异常升高或心电图改变作为免疫相关性心肌损害观察指标,并进行分组比较。数据均采用SPSS 19.0统计软件进行分析,以P<0.05为差异有统计学意义。结果 病例组PVF-Ar流速高于正常对照组,接受ICIs治疗后,16例患者(64.0%)存在心肌损害,其PVF-Ar流速更高。二元Logistic回归分析显示PVF-Ar流速是发生心肌损害的独立危险因素(OR:1.54, 95%CI:1.06~2.23,P<0.05)。结论 ICIs抗肿瘤治疗的老年患者PVF-Ar普遍升高,PVF-Ar异常升高可能与免疫相关性心肌损害有关,但还需进一步的前瞻性研究来验证。

Objective To analyze the spectral characteristics of pulmonary venous flow(PVF)in elderly patients with malignant tumors treated by immune checkpoint inhibitors(ICIs),and explore the value of PVF in immune⁃related myocardial damage.Methods From August 2020 to March 2023,25 patients with malignant tumors aged≥65 years who received ICIs treatment in Department of Medical Oncology,Jinshan Hospital were selected as the study subjects(case group),and another 24 normal subjects matching gender and age were selected as the control group.The peak velocity of PVF⁃S wave,PVF⁃D wave and PVF⁃Ar wave were measured by echocardiography.Routine examination of myocardial enzyme spectrum and electro⁃cardiogram were performed before and after treatment in the case group.The abnormal elevation of troponin I(TnI)or electro⁃cardiogram changes were used as the observation indexes of immune⁃related myocardial damage,and the comparisons were made between the two groups.All data were analyzed using SPSS 19.0 statistical software,and the difference was statistically significant when P<0.05.Results The peak velocity of PVF⁃Ar in the case group was higher than that in the control group.After receiving ICIs treatment,16 patients(64.0%)had myocardial damage and higher peak velocity of PVF⁃Ar.Binary Lo⁃gistic regression analysis showed that the peak velocity of PVF⁃Ar was an independent risk factor for myocardial damage(OR:1.54,95%CI:1.06⁃2.23,P<0.05).Conclusion The peak velocity of PVF⁃Ar is generally elevated in elderly patients treated with ICIs,and abnormal elevation of the peak velocity of PVF⁃Ar may be related to immune⁃related myocardial damage,but further prospective studies are needed to verify this.