Regional Cancer and Blood Research.
Department of Biochemistry, Auckland District Health Board, Auckland, New Zealand.
J Immunother. 2021 May 1;44(4):162-163. doi: 10.1097/CJI.0000000000000356.
Checkpoint inhibitor-associated myocarditis (ir-myocarditis) and myositis (ir-myositis) may occur concurrently among patients on checkpoint inhibitor immunotherapy. While cardiac-specific troponin I (cTnI) and troponin T (cTnT) are regarded to have similar sensitivities and specificities in conditions such as acute coronary syndrome, the cardiac specificity of cTnT has been challenged following observation that patients with neuromuscular diseases, including myositis, may have elevated cTnT without apparent clinical evidence of myocardial injury. Consequently, in the context of concurrent ir-myositis, cTnI may be a more appropriate biomarker for diagnosing and monitoring ir-myocarditis. To illustrate this point, we report a case of a patient with severe ir-myositis while on adjuvant programmed cell death protein 1 inhibitor immunotherapy for stage III melanoma, with accompanying elevation in cTnT.
检查点抑制剂相关心肌炎（ir-myocarditis）和肌炎（ir-myositis）可能同时发生在接受检查点抑制剂免疫治疗的患者中。虽然心肌肌钙蛋白 I（cTnI）和心肌肌钙蛋白 T（cTnT）在心梗等情况下被认为具有相似的敏感性和特异性，但在观察到包括肌炎在内的神经肌肉疾病患者的 cTnT 升高而无明显心肌损伤的临床证据后，cTnT 的心脏特异性受到了挑战。因此，在同时存在 ir-myositis 的情况下，cTnI 可能是诊断和监测 ir-myocarditis 的更合适的生物标志物。为了说明这一点，我们报告了一例接受辅助程序性细胞死亡蛋白 1 抑制剂免疫治疗 III 期黑色素瘤的患者出现严重的 ir-myositis 时，cTnT 升高的情况。
