免疫检查点抑制剂诱导心肌炎的预后:一个病例系列
Cyrille Coustal1, Juliette Vanoverschelde2, Xavier Quantin3
1Department of Internal Medicine, CHRU de Montpellier, Montpellier, France.
Journal for immunotherapy of cancer
|May 31, 2023
概括
免疫检查点抑制剂 (ICI) 治疗可以导致罕见但危及生命的心肌炎. 严重的病例通常伴有自身免疫性疾病,高水平的热波和特定的自身抗体,影响患者的预后.
科学领域:
- 心脏瘤学 - 心脏瘤学
- 免疫学 免疫学 免疫学
- 在瘤学瘤学.
背景情况:
- 免疫检查点抑制剂 (ICI) 已经彻底改变了癌症治疗.
- 免疫相关的不良事件 (irAEs) 是ICI治疗的已知副作用.
- 心肌炎是一种罕见但严重的与ICI治疗相关的irAE.
研究的目的:
- 为了表征ICI相关的心肌炎.
- 为了确定ICI相关心肌炎的预后因素.
- 为管理策略和潜在的ICI重新挑战提供信息.
主要方法:
- 多中心,横截面,回顾性研究.
- 根据国际心脏瘤学会的共识,诊断心肌炎.
- 分析临床数据,成像,实验室结果和结果.
主要成果:
- 确定了29名ICI相关心肌炎患者.
- 严重的病例与先前存在的自身免疫性疾病,高水平的氨酸和抗乙胆受体自身抗体有关.
- 死亡率是显著的,有24%的人经历了心肌炎相关的死亡,而其他人则屈服于癌症进展.
结论:
- 与ICI相关的心肌炎的管理是复杂的,需要多学科的方法.
- 识别预后特征有助于评估ICI重新挑战.
- 对患者来说,风险与益处的评估对于有着烂的表现的患者来说至关重要.
相关概念视频
Myocarditis III: Medical Management
9
Myocarditis: Comprehensive Medical ManagementMyocarditis, the heart muscle inflammation, requires a comprehensive medical management strategy that addresses the underlying cause, provides supportive care, manages symptoms, and reduces cardiac workload.Infections and Autoimmune CausesAdminister appropriate antimicrobial therapy when an infectious agent causes myocarditis. For instance, penicillin treats infections caused by Group A Streptococcus. In cases where autoimmune processes are...
9
Myocarditis IV: Nursing Management
13
Myocarditis is an inflammatory condition of the myocardium requiring meticulous nursing management for optimal patient outcomes. Effective management begins with a thorough assessment of the patient's medical history, paying close attention to past infections, autoimmune disorders, travel history, and exposure to toxins or drugs. Recent viral infections and systemic diseases are particularly relevant due to their potential role in triggering myocarditis.Physical Examination and MonitoringThe...
13
Myocarditis I: Introduction
12
Myocarditis is inflammation of the myocardium, which is the muscular layer of the heart.EtiologyMyocarditis has a diverse etiology, including a wide range of infectious and non-infectious causes:Infectious CausesViral: Common viruses include Coxsackie A and B, adenovirus, parvovirus B19, enteroviruses, and influenza A.Bacterial: Examples include infections caused by Streptococcus, Staphylococcus, and Mycoplasma species.Rickettsial: Infections like Rocky Mountain spotted fever can result in...
12
Myocarditis II: Clinical Features and Diagnostic Tests
12
Myocarditis is an inflammation of the heart muscle. The symptoms vary widely, encompassing asymptomatic presentations to severe, acute manifestations.Clinical PresentationAsymptomatic cases: In some instances, myocarditis may be asymptomatic, with the infection resolving without intervention. These cases often go undetected unless discovered incidentally through diagnostic imaging or tests conducted for other reasons.General Early Symptoms: Early symptoms of myocarditis are non-specific and can...
12
Pericarditis III: Medical Management
17
The primary objectives of managing pericarditis are to determine the underlying cause, provide effective therapy for treatment and symptom relief, and promptly detect signs and symptoms of cardiac tamponade. The following outlines the essential aspects of medical management for pericarditis:ObjectivesDetermine the Cause: Identifying the underlying cause of pericarditis is crucial for targeted treatment. Causes include viral infections, autoimmune diseases, post-cardiac injury syndrome, and...
17
Cardiomyopathy I: Introduction and Classification
24
Cardiomyopathy, or CMP, is a group of diseases affecting the myocardial structure, impairing its ability to pump blood effectively. This condition can lead to arrhythmias, heart failure, or sudden cardiac death.Cardiomyopathies are classified into primary and secondary categories:Primary Cardiomyopathy refers to conditions involving only the heart muscle that are often idiopathic (of unknown cause) or genetic. They primarily affect the myocardium without the involvement of other systemic...
24


