抗肿瘤免疫关卡抑制剂致心脏药物不良反应分析

目的 通过对免疫关卡抑制剂类药物致心脏不良反应文献的分析,探讨此类不良反应发生的规律,为临床合理应用免疫关卡抑制剂类药物提供参考。方法 以伊匹单抗（Ipilimumab）、纳武单抗（Nivolumab）、派姆单抗（Pembrolizumab）、阿特珠单抗（Atezolizumab）、"Avelumab "和" Durvalumab"为检索词对截止2017年9月的PubMed数据库进行致心脏药物不良反应文献检索,对患者的性别、年龄、原患疾病、药物使用情况及心脏不良反应临床表现等数据进行汇总并统计分析。结果 共收集17例免疫关卡抑制剂致心脏不良反应的个案报道,其中报道最多的是Ipilimumab,其次为Nivolumab和Pembrolizumab;心脏不良反应临床诊断以心肌炎为最多（58.8%）,其次为心律失常和心力衰竭;不良反应最快发生在首次用药后1周,最慢发生在首次用药后31周,中位数为9周;17例报告中有9例患者死亡。结论 临床应重视免疫关卡抑制剂类药物的心脏不良反应。

Analysis of Cardiac Adverse Reaction Induced by Immune Checkpoint Inhibitors

OBJECTIVE To study the features of adverse drug reaction in cardiovascular system induced by immune checkpoint inhibitors through literature analysis and provide reference for clinical rational use of immune checkpoint inhibitors. METHODS Literature about marketed immune checkpoint inhibitors-induced cardiac ADRs were collected from Pubmed database before September 2017 with "Ipilimumab", "Nivolumab", "Pembrolizumab", "Atezolizumab", "Avelumab" and "Durvalumab" as key words, and analyzed statistically in respect of patients'' gender, age, primary disease, drug use and clinical manifestations of cardiac ADRs. RESULTS A total of 17 cases of immune checkpoint inhibitors-induced cardiac ADRs were collected. Ipilimumab was most frequently reported. Nivolumab and Pembrolizumab were the second. Myocarditis was the most common diagnosis of cardiac toxicity(58.8%), followed by arrhythmia and heart failure. The fastest ADRs occurred at 1 week after the first dose, the slowest occurred at 31 weeks, the median was 9 weeks. Of the 17 patients, 9 died. CONCLUSION It should be payed more attention to the ADR of immune checkpoint inhibitors in cardiovascular system.