评估免疫检查点抑制剂治疗心脏不良事件的患者:EPICC研究
Kong Vang1, Jennifer Panich2, Connie Folz3
1University Hospital, University of Missouri, Columbia, MO, USA.
概括
免疫检查点抑制剂 (CPI) 可以导致罕见但严重的心脏问题,如心肌炎. 这项研究发现,CPI相关心肌炎发生在0.26%的患者中,心脏病发作史是潜在的危险因素.
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 (CPI) 是利用免疫系统的重要癌症治疗方法.
- 胰岛素感染可以引起与免疫相关的不良事件 (irAEs),包括罕见但严重的心血管事件,如心肌炎.
- 了解CPI诱导心脏毒性的发生率和危险因素至关重要,因为CPI利用率越来越高.
研究的目的:
- 评估发生率并确定与CPI在现实临床环境中的使用相关的心脏毒性,特别是心肌炎的危险因素.
主要方法:
- 在2013年10月至2021年9月期间接受CPI的1515名成年患者的回顾性队列研究.
- 图表审查侧重于在CPI治疗期间或30天内肌激素水平升高的患者.
- 用费舍尔精确测试来评估患者特征与CPI诱导的心肌炎之间的关联.
主要成果:
- 141名患者 (9.3%) 经历了较高的托罗邦水平.
- 在4名患者中确定了疑似CPI相关的心肌炎,发病率为0.26% (95%CI:0.07-0.67%).
- 被诊断为心肌炎的患者更有可能有心肌梗塞 (MI),STEMI或NSTEMI (P=0.01) 的病史.
结论:
- 与CPI相关的心肌炎是一种罕见的不良事件,与先前的研究相一致.
- 患有心肌梗塞的病史可能是发展CPI诱导心肌炎的危险因素.
- 需要进一步的研究,以充分阐明CPI相关心脏毒性风险因素.
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