免疫检查点抑制剂治疗膀胱癌相关免疫性心肌炎7例分析

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ABSTRACT：ObjectiveTo explore the clinical characteristics and treatment of immune checkpoint inhibitors（ICIs）- asociated myocarditis in patients with bladder cancer （BCa）.MethodsClinical and folow-up data of 213BCa patients treated with ICIs in our hospital during Jan.2O2O and May 2O24 were collcted.The data of 7 patients （3.3% ）who developed ICIs-aociated myocarditis were analyzed.ResultsThecohort included2 females and 5 males（medianage：72 years）.Four patients were asymptomatic，while 3presented withchest tightnessdyspnea，ororthopnea.All patientsshowed significantly elevated high-sensitivitytroponinT.Only2patientshad markedlyincreasedN-terminal pro-B-typenatriureticpeptide. Electrocardiograms werenormalin4patientswhile2patients exhibitedsignificantlyreducedleftventriculargloballongitudinal strain on echocardiography，with cardiac magneticresonanceconfirming acute myocarditis.Allpatients discontinued ICIs and received first-line methylprednisoloneupon diagnosis.Two patients showedno improvement after 5daysof treatmentand received second-linetherapy.Onepatientreceived intravenous immunoglobulinand infliximab withoutresponse，butimproved afterthird-line tofacitinib.Onepatient developed auterespiratoryfailure after intravenous immunoglobulinadministrationand wa then transfered to ICU，and diedof multiple organ failureafter1Odays.Conclusion ICIs-assciatedmyocarditis isa relativelyrarebutclinicalldistinctimmune-relatedadversereactionduringBCatreatment.Methylprednisoloneis thefirst-line therapy，whilecriticallyillandsteroid-resistantpatientsoftenrequireearlycombinedimmunosuppresantsbasedon individualized multidisciplinary discussion.

KEY WORDS：bladdercancer；immune checkpoint inhibitors；immune myocarditis；methylprednisolone；immune globulin; infliximab;tofacitinib;respiratory failure

摘要：目的探讨免疫检查点抑制剂（ICIs）治疗膀胱癌发生相关免疫性心肌炎患者的临床特征及临床诊疗方案。（剩余11804字）