He Yuwen, Chen Wanwen, Cai Junying, Luo Caiyin, Zhou Chengzhi, Wei Li
Department of Pharmacy, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
State Key Laboratory of Respiratory Disease, National Clinical Research Centre for Respiratory Disease, Guangzhou Institute of Respiratory Health, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
J Thorac Dis. 2023 Sep 28;15(9):4606-4619. doi: 10.21037/jtd-23-596. Epub 2023 Aug 14.
Immune checkpoint inhibitors (ICIs)-associated myocarditis remains a rare but fatal adverse event. The authors sought to provide a comprehensive clinical description of ICI-associated myocarditis by analyzing symptoms, laboratory indicators, imaging features, and management of ICI-associated myocarditis in patients with non-small cell lung cancer (NSCLC).
A retrospective study was conducted to analyze 14 ICI-associated myocarditis cases and 45 control patients to clarify clinical features of ICI-associated myocarditis. Detailed laboratory tests and imaging examinations were performed in 14 cases, and the rescue process and follow-up after the onset of myocarditis were recorded.
A total of 14 (2.08%) NSCLC patients developed ICI-related myocarditis, with a median time of onset of 34 days (interquartile range, 12 to 146 days) after ICI initiation. The most common concurrent adverse events in cases were myositis (P<0.001) and peripheral neuritis (P<0.001). Among cases, cardiac troponin I (cTnI) levels were abnormally elevated in 92% of patients, and electrocardiogram (ECG) showed abnormal in all cases. Steroid therapy was used in 92.9% of patients with ICI-associated myocarditis, of which the response rate to steroids was 76.9% and the mortality rate was 7.1%. A dose of 1 g/d of glucocorticoid supplemented by immunoglobulin was observed to be effective for severe myocarditis.
Early identification and treatment are essential for managing myocarditis caused by ICI. Routine monitoring of cTnI level and ECG is most sensitive for the early diagnosis of ICI-related myocarditis. High-dose of glucocorticoids can effectively relieve the symptoms of ICI-associated myocarditis and stabilize the condition, especially for fulminant myocarditis.
免疫检查点抑制剂（ICI）相关的心肌炎仍然是一种罕见但致命的不良事件。作者试图通过分析非小细胞肺癌（NSCLC）患者ICI相关心肌炎的症状、实验室指标、影像学特征及治疗情况，对其进行全面的临床描述。
进行一项回顾性研究，分析14例ICI相关心肌炎病例及45例对照患者，以明确ICI相关心肌炎的临床特征。对14例病例进行了详细的实验室检查和影像学检查，并记录了心肌炎发作后的抢救过程及随访情况。
共有14例（2.08%）NSCLC患者发生了ICI相关心肌炎，ICI开始使用后的中位发病时间为34天（四分位间距，12至146天）。病例中最常见的并发不良事件是肌炎（P<0.001）和周围神经炎（P<0.001）。病例中，92%的患者心肌肌钙蛋白I（cTnI）水平异常升高，所有病例的心电图（ECG）均显示异常。92.9%的ICI相关心肌炎患者使用了类固醇治疗，其中对类固醇的反应率为76.9%，死亡率为7.1%。观察到每日1 g剂量的糖皮质激素辅以免疫球蛋白对重症心肌炎有效。
早期识别和治疗对于管理由ICI引起的心肌炎至关重要。常规监测cTnI水平和ECG对早期诊断ICI相关心肌炎最为敏感。大剂量糖皮质激素可有效缓解ICI相关心肌炎的症状并稳定病情，尤其是对于暴发性心肌炎。
