摘要
免疫检查点表达于T细胞,参与免疫耐受、免疫监视等多种免疫过程,包括程序性死亡受体1及其配体程序性死亡受体配体1、细胞毒性T淋巴细胞相关抗原4。免疫检查点抑制剂(ICI)是一类与免疫检查点相结合的单克隆抗体,ICI与免疫检查点或其配体结合通过激活免疫监视的功能发挥抗肿瘤效应,但同时也打破了机体对自身抗原的免疫耐受平衡,使自身反应性T细胞的活性和数量明显增加,其与心肌肌球蛋白结合诱发ICI相关心肌炎;同时,白细胞介素-2、γ干扰素等炎症因子的大量释放进一步促进ICI相关心肌炎的发展,导致高死亡率。另一方面,ICI也会诱发血管炎症、促进斑块破裂,导致急性冠脉综合征。现从流行病学、危险因素、发病机制、临床表现、诊断、治疗、预后及未来展望讨论ICI相关心脏毒性。
Immune checkpoints such as programmed death-1(PD-1),programmed death-ligand 1(PD-L1)and cytotoxic T lymphocyte-associated antigen-4(CTLA-4)are expressed on T cells,participating in immune tolerance,immune surveillance and other immune processes.Immune checkpoint inhibitor(ICI)is a class of monoclonal antibodies that bind to immune checkpoints.Blocking the immune checkpoints could destroy tumors by activating immune system.However,it could increase the activity and number of self-reactive T cells because of the imbalance of immune tolerance,causing ICI myocarditis by combining with autoantigen of cardiac myosin.At the same time,the release of inflammatory factors such as interleukin-2(IL-2)and interferon-γ(IFN-γ)further promote the development of ICI myocarditis,leading to high mortality.On the other hand,ICI can also induce vascular inflammation and promote plaque rupture,leading to acute coronary syndrome.Therefore,this article will discuss the clinical characteristics of ICI-related cardiotoxicity from the following aspects:epidemiology,risk factors,pathogenesis,clinical manifestations,diagnosis,treatment and prognosis.
作者
邓悦
周晓阳
DENG Yue;ZHOU Xiaoyang(Department of Cardiology,Renmin Hospital of Wuhan University,Wuhan 430060,Hubei,China)
出处
《心血管病学进展》
CAS
2023年第10期905-910,共6页
Advances in Cardiovascular Diseases
基金
国家自然科学基金(81370037)。
关键词
免疫检查点抑制剂
心脏毒性
临床特点
Immune checkpoint inhibitor
Cardiotoxicity
Clinical characteristics
