免疫检查点抑制剂相关暴发性心肌炎合并严重肌炎1例

A Case Report about Immune Checkpoint Inhibitor-Related Fulminant Myocarditis Complicated with Severe Myositis

摘要: 免疫检查点抑制剂(immune checkpoint inhibitors, ICIs)是肿瘤治疗领域近年来取得的重大进展之一。随着ICIs的广泛应用，其免疫相关不良反应(immune-related adverse events, irAEs)也逐年增加。我们报道了1例肾癌患者在使用替雷丽珠单抗治疗后发生ICIs相关的暴发性心肌炎和严重肌炎。在早期诊断的基础上，我们运用体外氧合膜肺(Extracorporeal Membrane Oxygenation, ECMO)技术纠正休克、维持循环，积极应用激素冲击辅以免疫球蛋白、血浆置换等治疗，患者心功能逐步好转。后期经过长达3个月的支持治疗和康复训练，患者肌力恢复，好转出院。本文旨在为临床医生识别、诊断以及治疗irAEs提供参考。

Abstract: Immune checkpoint inhibitors (ICIs) are one of the major advances in the field of tumor treatment in recent years. With the widespread application of ICIs, their immune-related adverse events (irAEs) have also increased year by year. We report a case of a renal cancer patient who developed ICI-related fulminant myocarditis and severe myositis after treatment with tislelizumab. Based on early diagnosis, we used extracorporeal membrane oxygenation (ECMO) technology to correct shock and maintain circulation, and actively applied hormone shock therapy supplemented by immunoglobulin and plasma exchange. The patient’s cardiac function gradually improved. After up to three months of supportive treatment and rehabilitation training in the later stage, the patient’s muscle strength recovered and was discharged with improvement. This article aims to provide a reference for clinicians to identify, diagnose and treat irAEs.