Lu R, Lu J, Liao Y, Luo W J, Wang M, Lu M J
Department of Vasculocardiology, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou510120, China.
Department of Neurology, the First Affiliated Hospital of Hainan Medical University, Haikou570102, China.
Zhonghua Xin Xue Guan Bing Za Zhi. 2024 Nov 24;52(11):1290-1295. doi: 10.3760/cma.j.cn112148-20231210-00489.
To explore the risk factors of major adverse cardiovascular events (MACEs) in immune checkpoint inhibitor (ICI) related myocarditis and establish a predictive model. This was a retrospective case-control study. Tumor patients diagnosed with ICI related myocarditis in the First Affiliated Hospital of Guangzhou Medical University from May 2019 to August 2023 were selected and divided into non-MACE group and MACE group based on whether MACE occurred. Clinical and imaging data of the two groups were collected. Univariate and multivariate logistic regression models were used to analyze the risk factors for MACE in patients with ICI related myocarditis. According to the results of multivariate logistic regression analysis, R 4.1.0 software was used to construct the MACE risk prediction model for these patients and draw a nomogram. The receiver operating characteristic curve was used to evaluate the prediction ability of the prediction model. A total of 35 patients with ICI related myocarditis, aged (63.9±8.2) years, were included, including 28 males (80%). There were 18 patients in the non-MACE group and 17 patients in the MACE group. Multivariate logistic regression analysis showed that elevated neutrophil to lymphocyte ratio (=1.115, 95% 1.007-1.235, =0.036) and ST-T segment changes (=24.942, 95% 1.239-502.194, =0.036) were risk factors for MACE in patients with ICI related myocarditis. The receiver operating characteristic curve indicated that the area under the curve of the prediction model was 0.967 (95% 0.916-1.000, <0.001), with a sensitivity of 88.2% and specificity of 100%, demonstrating good predictive ability. Elevated neutrophil to lymphocyte ratio and ST-T segment change are independent risk factors for MACE in patients with ICI related myocarditis. Risk prediction model based on the above two indicators can assist in the early identification and individualized intervention of ICI related myocarditis patients.
探索免疫检查点抑制剂（ICI）相关心肌炎患者发生主要不良心血管事件（MACE）的危险因素并建立预测模型。本研究为回顾性病例对照研究。选取2019年5月至2023年8月在广州医科大学附属第一医院诊断为ICI相关心肌炎的肿瘤患者，根据是否发生MACE分为非MACE组和MACE组。收集两组患者的临床及影像学资料。采用单因素和多因素logistic回归模型分析ICI相关心肌炎患者发生MACE的危险因素。根据多因素logistic回归分析结果，使用R 4.1.0软件构建这些患者的MACE风险预测模型并绘制列线图。采用受试者工作特征曲线评估预测模型的预测能力。共纳入35例ICI相关心肌炎患者，年龄（63.9±8.2）岁，其中男性28例（80%）。非MACE组18例，MACE组17例。多因素logistic回归分析显示，中性粒细胞与淋巴细胞比值升高（β = 1.115，95%CI 1.007 - 1.235，P = 0.036）和ST - T段改变（β = 24.942，95%CI 1.239 - 502.194，P = 0.036）是ICI相关心肌炎患者发生MACE的危险因素。受试者工作特征曲线表明，预测模型的曲线下面积为0.967（95%CI 0.916 - 1.000，P < 0.001），敏感性为88.2%，特异性为100%，显示出良好的预测能力。中性粒细胞与淋巴细胞比值升高和ST - T段改变是ICI相关心肌炎患者发生MACE的独立危险因素。基于上述两个指标的风险预测模型可协助早期识别ICI相关心肌炎患者并进行个体化干预。
