卡瑞利珠单抗相关免疫性心肌炎文献病例分析

Literature Analysis on Camrelizumab-Related Immune Myocarditis

目的:探讨卡瑞利珠单抗相关免疫性心肌炎发生的临床特点,为临床合理用药提供参考。方法:检索中国知网、万方数据库、维普数据库、PubMed、Embase、Wiley Online Library等数据库(检索时限为建库至2023年10月),收集卡瑞利珠单抗相关免疫性心肌炎的个案报道并进行汇总分析。结果:共纳入22篇卡瑞利珠单抗相关免疫性心肌炎的个案报道文献,涉及23例患者,其中男性患者13例(占56.52%),女性患者10例(占43.48%);平均年龄为64.61岁;临床诊断主要为肺癌(7例,占30.43%)、肝癌(5例,占21.74%);发生免疫性心肌炎的中位时间为首次用药后23 d;最常见的临床症状为乏力(9例)、眼睑下垂(7例)、胸闷(7例)、肌肉酸痛或无力(6例);患者全部使用糖皮质激素或联合其他处理,18例好转,4例死亡,1例继发心力衰竭,休克后自动出院。结论:卡瑞利珠单抗导致免疫性心肌炎的发生率低、致死率高,因此,启动免疫治疗前应全面评估患者的心功能,治疗期间应定期监测心功能指标、心电图或超声心动图表现,怀疑发生免疫性心肌炎时应尽早应用糖皮质激素或联合其他治疗。是否可以重启免疫治疗,应综合考虑患者意愿和多学科会诊评估结果后决定。

OBJECTIVE:To probe into the clinical characteristics of camrelizumab-related immune myocarditis,so as to provide reference for clinical rational medication.METHODS:CNKI,Wanfang Data,VIP,PubMed,Embase,Wiley Online Library were retrieved(the retrieval time was from the establishment of the database to Oct.2023),case reports on camrelizumab-related immune myocarditis were collected and analyzed.RESULTS:A total of 22 case reports on camrelizumab-related immune myocarditis were enrolled,including 23 patients,of which 13(56.52%)were males and 10(43.48%)were females;the average age was 64.61 years;the main clinical diagnoses were lung cancer(7 cases,30.43%)and liver cancer(5 cases,21.74%);the median time of the occurrence of immune myocarditis was 23 d after the first medication.The most common clinical symptoms were weakness(9 cases),blepharoptosis(7 cases),chest distress(7 cases),and muscle soreness or weakness(6 cases).All the patients were treated with glucocorticosteroids or in combination with other treatments,and 18 cases got better,4 cases died,1 case had secondary heart failure and left hospital without cure after shock.CONCLUSIONS:Camrelizumab causes low incidence and high lethality of immune myocarditis.Therefore,comprehensive assessment on cardiac function should be conducted before initiating immunotherapy.Cardiac function indicators,electrocardiogram or echocardiography should be regularly monitored during treatment,and glucocorticosteroids or in combination with other treatments should be applied as early as possible when immune myocarditis is suspected.Whether immunotherapy can be restarted should be decided based on the patients’willingness and the results of multidisciplinary consultation evaluation.