摘要
免疫检查点抑制剂(ICIs)是恶性肿瘤治疗的重大突破,已在多种实体肿瘤中广泛应用,并取得良好疗效。其中,针对细胞毒性T淋巴细胞抗原-4(CTLA-4)和程序性死亡受体-1/配体-1(PD-1/PD-L1)的ICIs治疗效果显著。其通过激活或增强免疫系统对肿瘤细胞的反应来发挥作用,并改变了现有癌症治疗的格局,目前多种ICIs已被批准用于不同恶性肿瘤的治疗。然而,各种器官和组织的ICIs相关多种免疫不良反应的报道也日趋增多。免疫相关心脏毒性反应虽发生率低,但病死率极高。心肌炎是ICIs心脏毒性常见的类型,发病机制复杂,且症状具有非特异性,缺乏有效的预测指标,容易引起误诊或漏诊,增加了治疗的困难程度,并且重症心肌炎治疗效果欠佳,预后极差,如何早期诊断并治疗对于提高患者预后具有重要价值。本研究就ICIs相关心肌炎的起因、发病机制、危险因素、临床表现、诊断和治疗策略等进行综述,从而为临床防治ICIs相关心肌炎提供指导。
Nowadays,immune checkpoint inhibitors(ICIs)have become a major breakthrough in the treatment of malignant tumors,which have been widely used clinically in a variety of solid tumors and achieved good curative effects.The ICIs targeting cytotoxic T lymphocyte antigen-4(CTLA-4)and programmed death receptor-1/ligand-1(PD-1/PD-L1),which can activate or enhance the innate immunity to kill tumor cells,have yielded remarkable therapeutic effects and are changing the traditional pattern of cancer treatments.ICIs have been approved for the treatment in a variety of malignant tumors.However,there are increasing reports of multiple adverse reactions in various organs and tissues related to ICIs.Although the incidence of immune-related cardiotoxicity is low,the mortality is extremely high once it occurs.Myocarditis is a common type of ICIs cardiotoxicity.The pathogenesis is complex,and the symptoms are non-specific.There is no effective biomarker to predict myocarditis.It is easy to cause misdiagnosis or missed diagnosis,which increases the difficulty of treatment.The prognosis is very poor and even life-threatening if it happens.Early detection,diagnosis and treatment are of great value in improving the prognosis of patients.Thus,this literature reviews the causes,pathogenesis,risk factors,clinical manifestations,diagnosis and treatment strategies of ICIS-related myocarditis,so as to provide guidance for clinical prevention and treatment of ICIs-related myocarditis.
作者
石宏伟
唐恒
韩光
皮国良
胡德胜
蒲鹏
王琳琳
SHI Hong-wei;TANG Heng;HAN Guang;PI Guo-liang;HU De-sheng;PU Peng;WANG Lin-lin(Department of Radiation Oncology,Hubei Cancer Hospital,Tongji Medical College,Huazhong University of Scienceand Technology,Wuhan 430079,China;Department of Radiation Oncology,Shandong Cancer Hospital and Institute,Shandong First Medical University and Shandong Academy of Medical Sciences,Jinan 250117,China;Department of Cardiology,First Affiliated Hospital of Chongqing Medical University,Chongqing 400042,China)
出处
《中华肿瘤防治杂志》
CAS
北大核心
2022年第16期1159-1164,1183,共7页
Chinese Journal of Cancer Prevention and Treatment
基金
中国博士后基金(2019M652612)
湖北省卫健委基金(2020VBF142)
作者简介
第一作者:石宏伟,男,河南信阳人,博士,主治医师,主要从事胸部肿瘤放射治疗的研究工作。E-mail:shwwhu2008@126.com;通信作者:王琳琳,女,山东临沂人,博士,主任医师,主要从事胸部肿瘤放射治疗的研究工作。E-mail:wanglinlinatjn@163.com,肿瘤学博士后,主任医师,博士研究生导师,山东省肿瘤医院胸放三病区科主任,澳大利亚国家公派访问学者,山东省“泰山学者”青年专家,首届齐鲁卫生与健康杰出青年人才。擅长肺癌、乳腺癌、食管癌等胸部肿瘤的诊断与精准治疗。主持国家自然科学基金、中国博士后基金面上一等资助、山东省自然科学基金等科研项目9项,参与项目10余项。获国家发明专利1项,获中国抗癌协会科技进步一等奖、山东医学科技奖二等奖、山东省保健协会科技奖一等奖、第十届济南市青年科技奖等奖励。兼任山东省抗癌协会肺癌分会副主任委员,山东省抗癌协会肿瘤免疫与免疫治疗分会副主任委员,山东省抗癌协会肿瘤靶向治疗分会常务委员,山东省抗癌协会肿瘤精准治疗分会常务委员等,发表中英文期刊论文40余篇,其中SCI收录30余篇,以第一或通讯作者发表SCI收录论文20余篇,总影响因子100余分。是《BMC Cancer》《Radiation Oncology》等多个SCI收录期刊审稿人
