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免疫检查点抑制剂和心血管不良事件
Maria Luisa De Perna1, Elia Rigamonti1, Raffaele Zannoni2
1Istituto Cardiocentro Ticino, Department of Cardiology, Ente Ospedaliero Cantonale, Lugano, Switzerland.
ESC heart failure
|April 10, 2025
概括
免疫检查点抑制剂 (ICI) 提供了癌症治疗的进步,但可以导致严重的心血管不良事件 (CVAes),包括心肌炎和心力衰竭. 早期识别和多学科管理对于改善患者的治疗结果至关重要.
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:
- 免疫疗法,特别是免疫检查点抑制剂 (ICI),已经彻底改变了癌症治疗.
- 抗胰岛素增强免疫系统的抗癌活性,但可能导致与免疫相关的不良事件 (irAEs).
- 心血管不良事件 (CVAes) 是与ICI治疗相关的一个重大问题.
研究的目的:
- 审查与免疫检查点抑制剂相关的心血管不良事件的范围.
- 讨论ICI诱导的CVAes的临床表现,分级和管理策略.
- 强调协作护理在应对这些事件中的重要性.
主要方法:
- 对与免疫检查点抑制剂相关的心血管不良事件的文献综述.
- 对CVAes的临床表现,诊断标准和治疗方案的分析.
- 综合当前关于病理生理学和管理的理解.
主要成果:
- 常见的CVA包括心肌炎,心膜炎,心力衰竭,心律失常和加速动脉样硬化.
- 肌心炎虽然很少见,但死亡率很高 (25-50%),需要及时免疫抑制.
- 管理包括持有ICI,免疫抑制疗法 (糖皮质类药物) 和支持性心脏护理.
- 胸膜炎的治疗因流血的严重程度而异,可以选择NSAIDs,colchicine和心膜切开术.
结论:
- 心血管不良事件是接受免疫检查点抑制剂的患者的关键考虑因素.
- 快速诊断和涉及心脏病学家和瘤学家的多学科方法对于有效的管理至关重要.
- 需要进一步的研究来阐明ICI相关CVAes的机制和优化治疗策略.
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