PD-1抑制剂致免疫相关性心肌炎的病例分析

Case Analysis of Immune-Related Myocarditis Induced by PD-1 Inhibitors

目的:总结PD-1单抗致免疫相关性心肌炎发生的规律、特点、治疗和预后。方法:回顾性分析2020年3月~2022年1月在青岛大学附属烟台毓璜顶医院进行PD-1单抗治疗的6例患者,总结其临床资料。结果:6例患者中,男性5例、女性1例,平均年龄为68.33岁;临床诊断肺癌4例、胃癌、结肠癌各1例;半数患者的免疫性心肌炎出现在使用PD-1抑制剂第一周期后,平均发生时间为末次用药后的20.83天。全部患者都使用了糖皮质激素处理且心功能都得到了恢复后均未再重启免疫治疗。结论:当患者使用PD-1抑制剂治疗时,需做好心脏功能相关基线检查和常规监测,如怀疑发生免疫相关性心肌炎,尽早完善心功能相关检查并使用大剂量糖皮质激素治疗,必要时可加用其他免疫抑制剂和其他对症治疗措施。

Objective: To investigate the characteristics, treatment and prognosis of immune-related myocarditis induced by PD-1 inhibitors. Methods: We retrospectively analyzed the clinical data of 6 advanced tumor patients who received PD-1 inhibitors therapy in Qingdao Affiliated Yantai Yuhuangding Hospital from March 2020 to January 2022. Results: 6 patients were involved, including 5 males and 1 female, with an average age of 68.33 years. There were 4 cases of lung cancer, 1 case of gastric cancer, 1 case of colon cancer. Immunological myocarditis of 50% patients occurred after the first cycle of PD-1 inhibitors administration, and the average occurrence time was 20.83 days after the last administration. All patients were treated with glucocorticoids when they developed immune-associated myocarditis. Both the symptoms and cardiac function had recovered and none of these patients restarted with immunotherapy. Conclusions: Baseline examination and monitoring of cardiac function should be done when patients are treated with PD-1 inhibitors. Once immune-related myocarditis is suspected, cardiac function-related tests should be performed timely. Immediate initiation of high-dose glucocorticoid therapy and other immunosuppressant should be considered.