[关键词]
[摘要]
目的 探讨阿替利珠单抗相关心脏不良反应的临床特点、发生规律、治疗效果及转归,为临床合理用药及心脏不良反应的防治提供依据。方法 检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、Web of Science数据库,收集自建库至2025年3月发表的阿替利珠单抗相关心脏不良反应案例报道文献,对符合要求的病例临床资料进行统计和分析。结果 共纳入35篇文献,涉及36名患者,男女比例约2∶1;60岁以上患者居多;原患疾病以肺癌为主,合并心脏基础疾病和高血压的患者较多;不良反应以心肌炎多见,少数患者出现说明书未注明的新的不良反应;不良反应发生时间多在用药1个周期后;86.11%患者有明显临床症状,症状常见为呼吸困难,15例患者伴随其他系统不良反应和相应临床症状;实验室检查多见肌钙蛋白I、脑利钠肽、肌酸激酶等心脏生物标记物的升高;心电图检查以传导阻滞、ST段异常、心动过速较常见;超声心动图多见射血分数降低、左心室壁运动减弱、心包积液;冠状动脉造影基本正常;心脏核磁共振多见心室壁运动异常,病理学多见混合型炎性细胞浸润;经停药、手术、糖皮质激素及其他对症支持治疗后,部分患者心脏功能恢复,大于1/3的患者死亡。结论 阿替利珠单抗相关心脏不良反应不容忽视,临床医生应加强对使用该药物患者的心脏监测,早期识别和干预心脏不良反应,以改善患者预后。
[Key word]
[Abstract]
Objective To analyze the clinical characteristics, occurrence patterns, treatment effects, and outcomes of cardiac adverse reactions associated with atezolizumab, providing a basis for rational clinical drug use and the prevention and treatment of cardiac adverse reactions. Methods Databases such as CNKI, Wanfang Database, VIP Database, Chinese Biomedical Literature Service System, PubMed, and Web of Science were searched to collect literature on case reports of cardiac adverse reactions related to atezolizumab published from the establishment of the databases to March 2025. The clinical data of eligible cases were statistically analyzed. Results A total of 35 articles were included, involving 36 patients, with male and female ratio of approximately 2:1. Most patients were over 60 years old. Lung cancer was the primary underlying disease, and many patients had underlying heart diseases and hypertension. Myocarditis was the most common adverse reaction, and a few patients developed new adverse reactions not noted in the drug instructions. The adverse reactions mostly occurred after one cycle of medication. 86.11% of the patients had obvious clinical symptoms, with dyspnea being the most common. 15 patients had adverse reactions in other systems and corresponding clinical symptoms. Laboratory tests often showed increased cardiac biomarkers such as troponin I, brain natriuretic peptide, and creatine kinase. Electrocardiogram examinations commonly showed conduction block, ST - segment abnormalities, and tachycardia. Echocardiograms often showed reduced ejection fraction, weakened left ventricular wall motion, and pericardial effusion. Coronary angiography was basically normal. Cardiac magnetic resonance imaging often showed abnormal ventricular wall motion, and pathology often showed mixed inflammatory cell infiltration. After drug withdrawal, surgery, glucocorticoid treatment, and other symptomatic and supportive treatments, the cardiac function of some patients recovered, and more than 1/3 of the patients died. Conclusion Cardiac adverse reactions associated with atezolizumab cannot be ignored. Clinicians should strengthen cardiac monitoring of patients taking this drug, identify and intervene in cardiac adverse reactions at an early stage to improve the prognosis of patients.
[中图分类号]
R979.1
[基金项目]
天津市卫生健康科技项目资助项目(TJWJ2024MS062)