1例信迪利单抗注射液致免疫相关性心肌炎的病例报道与分析

Reporting and Analysis of a Case of Immune-Related Myocarditis Caused by Sintilimab Injection

目的:探讨信迪利单抗致免疫相关性心肌炎的临床表现以及用药监护,以期为免疫相关不良反应的防治及合理用药提供参考。方法:选取国家药品不良反应监测中心(海口数据库)收到的1例信迪利单抗注射液致免疫相关性心肌炎的典型病例,进行病例回顾,探讨免疫相关性心肌炎的临床特点及治疗方法。结果:应用信迪利单抗注射液抗肿瘤治疗后,患者心肌酶谱指标超敏肌钙蛋白、肌酸激酶同工酶MB以及心衰指标N末端脑钠肽前体等均升高,同时心电图提示心动过速,临床考虑出现免疫相关性心肌炎不良反应,给予甲泼尼龙治疗后症状均有所好转。结论:临床应用信迪利单抗联合化疗时,应密切监测心肌炎的临床症状和体征,一旦出现心脏毒性,需及时完善心脏功能相关检查和合理使用糖皮质激素治疗,从而避免严重不良反应的发生,有效改善患者预后。

Objective:To investigate the clinical manifestations and medication monitoring of immune-related myocarditis caused by sintilimab,so as to provide a reference for prevention and treatment of immune-related adverse reactions and rational drug use.Methods:A typical case of immune-related myocarditis caused by sintilimab injection reported to the National Center for ADR Monitoring(Haikou Database)was selected and reviewed to investigate the clinical characteristics and treatment method for immune-related myocarditis.Results:After receiving sintilimab injection for anti-tumor treatment,the patient's cardiac enzyme profile indicators(high-sensitivity troponin and creatine kinase isoenzyme-MB)and the heart failure indicator(N-terminal pro-brain natriuretic peptide)were elevated,while the electrocardiogram showed tachycardia.Clinically,an adverse reaction of immune-related myocarditis was considered,and the symptoms were improved after treatment with methylprednisolone.Conclusion:Clinical symptoms and signs of myocarditis should be closely monitored when sintilimab combined with chemotherapy is used in clinical practice.Once cardiotoxicity occurs,thorough cardiac function related tests should be conducted in time,along with rational use of glucocorticoid therapy,to prevent serious adverse reactions and effectively improve the prognosis of patients.