免疫检查点抑制剂相关心肌炎:病例报告的系统分析
Caie Wang1, Guo Zhao2, Zhen Zhang1
1Department of Pharmacy, the First Affiliated Hospital of Henan University of Science and Technology, Luoyang, Henan, China.
Frontiers in immunology
|October 25, 2023
概括
免疫检查点抑制剂 (ICI) 治疗可以导致心肌炎,这是一个严重的疾病. 早期停止ICI和及时进行葡萄糖皮质激素治疗可以改善患者的治疗结果,并允许潜在的重新挑战.
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) 是关键的癌症疗法,但可能导致心血管毒性,特别是心肌炎.
- 对于ICI相关心肌炎的最佳管理策略尚未建立,从病例报告中获得的证据有限.
- 本系统分析旨在整合有关ICI相关心肌炎的现有数据,以指导临床实践.
研究的目的:
- 系统地分析ICI相关心肌炎病例报告和病例系列.
- 评估新出现的证据,以优化ICI相关心肌炎的管理.
- 为临床医生提供数据驱动的洞察力,用于管理ICI相关心肌炎.
主要方法:
- 对ICI相关心肌炎的病例报告和系列进行了系统的文献搜索.
- 包括PubMed数据库中的2018年1月至2023年5月的出版物.
- 从113篇涉及106名患者的出版物中提取和分析了数据.
主要成果:
- 与ICI相关的心肌炎是一种严重的,可能危及生命的疾病 (53.8%的死亡率).
- 严重的病例 (G3-G4) 往往需要葡萄糖皮质类药物,与ICI中止和葡萄糖皮质类药物使用相关的更高改善率.
- 治疗建议因严重程度而异:G3-G4心肌炎需要积极的治疗,包括ICI停药和高剂量的葡萄皮质激素,而G1-G2病例可以使用定期剂量的葡萄皮质激素来治疗.
结论:
- 停止ICI和及时服用葡萄糖皮质激素对于管理ICI相关心肌炎至关重要.
- 治疗策略应根据心肌炎的严重程度 (G1-G4) 量身定制.
- 在心肌炎解决或显著改善后,可以考虑重新挑战ICI.
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