抗PD-1治疗引起重症肌无力合并心肌炎病例报道1例并文献复习

A Case Report of Myasthenia Gravis Complicated with Myocarditis Caused by Anti-PD-1 Therapy and Literature Review

摘要: 目前免疫检查点抑制剂针对恶性肿瘤有较好的疗效，但其引起的重度免疫相关的不良反应较少。1例70岁的男性肺鳞癌患者经治1月后出现视物模糊，上眼睑提肌无力，眼球运动障碍，颈部肌肉无力，无法平卧等临床症状，结合实验室检查及临床症状考虑为重症肌无力合并免疫相关性心肌炎，立即予以甲强龙联合丙种球蛋白治疗等综合治疗，后患者症状明显改善。结合该患者的诊疗方案我们得出结论，在应用卡瑞利珠单抗等抗PD-1治疗时，应监测患者肝肾功能、心肌酶谱、神经系统功能等指标，一旦出现免疫相关不良反应累及神经系统及心脏时，应立即并永久停药，并给予足够的皮质类固醇和免疫球蛋白治疗，同时可联合溴吡斯的明减少后遗症的发生。我们报道此例卡瑞利珠单抗治疗后诱发重症肌无力合并免疫相关性心肌炎通过治疗好转的病例，同时进行文献回顾，以期为重度免疫相关不良反应诊治提供一些治疗策略参考。

Abstract: At present, immune checkpoint inhibitors have a good effect on malignant tumors, but they cause few severe immune-related adverse reactions. A 70-year-old male patient with lung squamous cell carcinoma developed blurred vision, weakness of the levator muscle of the upper eyelid, eye movement disorder, neck muscle weakness, and inability to lie down one month after treatment. Combined with laboratory tests and clinical symptoms, the patient was considered as myasthenia gravis combined with immune-related myocarditis. Based on the diagnosis and treatment plan of this patient, we conclude that liver and kidney function, myocardial enzyme spectrum, and nervous system function should be monitored during the application of anti-PD-1 therapy such as Camrelizumab. Once immune-related adverse reactions occur involving the nervous system and heart, the drug should be stopped immediately and permanently, and adequate corticosteroid and immunoglobulin should be given. It can be combined with pyridostigmine bromide to reduce the occurrence of sequelae. We report a case of myasthenia gravis complicated with immune-related myocarditis induced by Camrelizumab and review the literature in order to provide some treatment strategies for the diagnosis and treatment of severe immune-related adverse reactions.