信迪利单抗致免疫相关性肌炎伴心肌炎/重症肌无力1例及文献回顾

Immune-related myositis with myocarditis/myasthenia gravis induced by sintilimab:a case report and literature review

目的 阐述信迪利单抗相关免疫性肌炎的临床特征、治疗现状及疾病预后。方法 分析本院1例信迪利单抗用药后发生肌炎的病例,并检索分析国内外数据库中的相关病例。结果 本院收治的病例经激素联合静注人免疫球蛋白(IVIG)治疗后指标好转,肌力改善。10例检索到的病例中,男性、高龄占比较大,中位起病时间为21 d。乏力、肌痛等临床症状常见,部分患者以眼睑下垂为首发症状。重叠综合征发生率高(8例,80%),常合并心肌炎、重症肌无力(MG)。肌酸激酶(CK)、肌钙蛋白等心肌酶指标明显升高。异常心电图检查结果常见(8例)。所有患者均接受激素治疗,其他合并治疗包括IVIG、血浆置换及辅助通气治疗。8例好转,2例重叠综合征患者死亡。结论 信迪利单抗相关免疫性肌炎多于用药后早期发生,死亡率较高。药物使用中应注意监测CK、肌钙蛋白等检查指标,关注乏力、肌痛等肌肉毒性预警因子。发生肌炎时,及时启用激素治疗,同时警惕肌炎-心肌炎-MG重叠综合征的发生。

Objective To elaborate the clinical characteristics,treatment and prognosis of immune-related myositis induced by sintilimab.Methods Excel 2019 software was used to analyze the clinical parameters from 1 case in our hospital and 10 cases of myositis after sintilimab administration retrieved from PubMed,CNKI and Wanfang databases.Results The indicators and muscle strength of the patient were improved after the treatment of hormone combined with intravenous immunoglobulin(IVIG).Male and elderly patients accounted for a larger proportion in all 10 cases retrieved.The median onset time was 21 d.Clinical manifestations such as fatigue and myalgia were common.Some patients had ptosis as the initial symptom.The incidence of overlap syndrome(n=8,80%)with myocarditis/myasthenia gravis(MG)was high.Myocardial enzyme indicators,such as serum creatine kinase(CK)and troponin were significantly elevated.Abnormal electrocardiogram was common(n=8).All patients received corticosteroids.Other interventions included IVIG,plasma exchange and assisted ventilation.Eight cases were improved,and 2 cases with overlap syndrome died.Conclusion Sintilimab-related immune myositis tends to occur early with high mortality rate.Laboratory indicators such as CK and troponin and warning factors of muscle toxicity such as weakness and myalgis should be closely monitored.Timely use of steroid hormone and maintaining vigilance to the overlap syndrome is necessary when myositis occurs.