免疫检查点与抑制剂相关的心肌炎:我们现在在哪里,我们将要去哪里
Andrea Vergara1,2, Marco De Felice3,4, Arturo Cesaro1,2
1Department of Translational Medical Sciences, University of Campania 'Luigi Vanvitelli', Caserta, Italy.
Angiology
|September 12, 2023
概括
免疫检查点抑制剂 (ICI) 改善了癌症治疗,但可能导致心肌炎. 使用心电图和超声波的早期检测以及有针对性的治疗对于管理这种诊断不足的副作用至关重要.
科学领域:
- 心脏病学 心脏病学
- 在瘤学瘤学.
- 免疫学 免疫学 免疫学
背景情况:
- 免疫检查点抑制剂 (ICI),如抗PD1/PD-L1和抗CTLA-4,可以增强抗癌T细胞的反应.
- 虽然对于晚期癌症有效,但ICI可能会导致与免疫相关的不良事件,包括心肌炎.
- ICI诱导的心肌炎的诊断不足,表征不佳,这带来了临床挑战.
研究的目的:
- 审查目前对与免疫相关的不良心血管事件的理解,特别是ICI诱导的心肌炎.
- 专注于组织学和临床特征,诊断和管理战略.
- 探索ICI相关心肌炎的当前治疗方法和潜在的未来治疗目标.
主要方法:
- 关于免疫检查点抑制剂和心肌炎的当前文献的综述.
- 对心电图和超声波等诊断工具进行分析,以早期检测.
- 检查现有和潜在的未来治疗干预措施.
主要成果:
- ICI治疗可能导致T细胞过度活化,导致多器官损伤,如淋巴细胞心肌炎.
- 早期诊断的红旗包括QRS复杂扩大和减少全球纵向应变 (GLS) 在超声波上.
- 目前的治疗包括免疫抑制剂,单克隆抗体和融合蛋白.
结论:
- ICI诱导的心肌炎是一种显著的,往往被低估的并发症,需要更好的表征和诊断方法.
- 使用特定的临床和心电图/超声波发现的及时诊断是必不可少的.
- 未来对可能涉及microRNAs的新疗法进行研究是有效管理的必要条件.
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