卡瑞利珠单抗致免疫相关性心肌炎的临床特征分析

Analysis of clinical features of immune-associated myocarditis induced by camrelizumab

目的探讨卡瑞利珠单抗致免疫相关性心肌炎的临床特征,为临床安全用药提供参考。方法检索中国知网、维普资讯、万方数据知识服务平台、中国生物医学文献服务系统、百度学术、PubMed和Web of Science等数据库中关于卡瑞利珠单抗致免疫相关性心肌炎的个案报道,检索时间自数据库建库至2023年9月,筛选提取数据并进行临床特征分析。结果共获得17篇文献,涉及18例患者,男8例,女10例,年龄45~75岁,平均(63.28±9.09)岁,原患疾病均为恶性肿瘤;卡瑞利珠单抗用法用量主要为200 mg静脉滴注,每3周1次;多在给药后1个月内发生免疫相关性心肌炎;常见的临床表现为乏力和胸闷,心电图异常主要表现为ST-T改变。经停药和对症治疗后,11例好转,4例未好转,3例死亡。结论卡瑞利珠单抗可能导致免疫相关性心肌炎,严重者可导致死亡,临床应加强卡瑞利珠单抗的合理使用,重视其引起的免疫相关性心肌炎,发生不良反应时应及时救治,让更多的患者在免疫治疗中获益。

Objective To explore the clinical features of immune-associated myocarditis induced by camrelizumab,and to provide a reference for clinical drug use.Methods Case reports on immune-associated myocarditis induced by camrelizumab were searched from CNKI,VIP,Wanfang Data,SinoMed,Baidu Academic,PubMed,Web of Science,and other databases from inception to September 2023.The data were screened and extracted,and the patient′s characteristics were analyzed.Results A total of 17 articles were obtained,involving 18 patients,8 males and 10 females,aged 45 to 75 years old,with an average age of(63.28±9.09)years old.The original diseases were all malignant tumors.The main dosage of camrelizumab was 200 mg intravenously,once every 3 weeks.Immune-associated myocarditis usually occurs within 1 month after administration.The common clinical manifestations were fatigue and chest tightness,and the main manifestations of electrocardiogram abnormalities were ST-T changes.After drug withdrawal and symptomatic treatment,11 cases improved,4 cases did not improve,and 3 cases died.Conclusion Camrelizumab may lead to immune-associated myocarditis,which can be fatal in severe cases.Clinicians should use camrelizumab rationally,pay attention to immune-associated myocarditis it may cause,and provide timely treatment for adverse reactions to benefit more patients from immunotherapy.