免疫检查点抑制剂在恶性肿瘤患者中的心血管不良事件风险分析:系统综述与荟萃分析

Cardiovascular adverse events of ICIs in patients with malignancies:Systematic review and meta-analysis

目的:系统评估抗肿瘤药物免疫检查点抑制剂(ICIs)在治疗恶性肿瘤患者时发生心血管不良事件的风险。方法:在4个数据库中搜索了建库以来所有关于ICIs的心血管不良事件的随机对照试验,并将数据汇总分析,计算优势比及其95%置信区间。结果:共有62项随机对照试验被纳入。与安慰剂/化疗相比,单药ICIs研究的全部级别总体心脏和血管不良事件风险增加。尤其是全部等级和≥3级的心肌炎均较对照组有显著差异,除心包疾病外,其余方面并未显示出ICIs使用的显著毒性。结论:单药ICIs的使用会增加恶性肿瘤患者心血管不良事件的风险,因此,在使用前应详细评估患者基础心血管情况。

Objective:To systematically analyze the risk of cardiovascular adverse events in patients treated with immune checkpoint inhibitors(ICIs),a star in anti-tumor therapy.Methods:Researchers searched 4 databases for all randomized controlled trials about ICIs for cardiovascular adverse events.Data were pooled into a stratified meta-analysis and the odds ratio and its corresponding 95%confi-dence interval were calculated.Results:A total of 62 randomized controlled trials were included in the analysis.The all-grade cardiac adverse events and vascular adverse events of single ICIs were signifi-cantly different from that of the control group,and in particular,all grades or≥grade 3 of myocarditis were more significant.No other significant adverse events were shown in the ICIs group except for pericardial diseases.Conclusion:The results revealed that single ICIs could increase the risk of car-diovascular adverse events of all grades,especially myocarditis and pericardial diseases.Therefore,the patient's cardiovascular basis should be evaluated in detail before using ICIs.