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| 免疫检查点抑制剂相关心肌炎临床诊疗实施建议 |
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王妍1, 陈慧勇2, 林瑾仪3,4,5, 陈佳慧3,4,5, 周宇红1, 张英梅3,4,5, 张宏伟6, 朱玮6, 胡洁7, 赵刚3,4,5, 杨向东8,4, 杜世锁9, 李晓宇10, 施国明11, 崔洁3,4,5, 吴薇10, 李静10, 章箎3,4,5, 王聪3,4,5, 刘荣乐3,4,5, 李政12,4,5,13, 王春晖10, 程蕾蕾12,4,5,13, 葛均波3,4,5
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1.复旦大学附属中山医院肿瘤内科, 上海 200032;2.复旦大学附属中山医院风湿免疫科, 上海 200032;3.复旦大学附属中山医院心内科, 上海 200032;4.国家放射与治疗临床医学研究中心, 上海 200032;5.上海市心血管病研究所, 上海 200032;6.复旦大学附属中山医院普外科, 上海 200032;7.复旦大学附属中山医院呼吸科, 上海 200032;8.上海市心血管病研究所中心实验室, 上海 200032;9.复旦大学附属中山医院放疗科, 上海 200032;10.复旦大学附属中山医院药剂科, 上海 200032;11.复旦大学附属中山医院肝肿瘤外科, 上海 200032;12.复旦大学附属中山医院心脏超声诊断科, 上海 200032;13.上海市影像医学研究所, 上海 200032
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| 摘要: |
| 免疫检查点抑制剂（immune checkpoint inhibitors，ICIs）已被应用于治疗多种恶性肿瘤，为患者带来显著临床获益的同时，也带来了一系列并发症风险。ICIs相关心肌炎是其中较严重的并发症之一，日益为临床带来新挑战。本临床诊疗实施建议聚焦ICIs相关心肌炎的危险因素、诊断与鉴别诊断、临床分型及治疗、监测转归和治疗重启等关键临床问题，参考国内外相关共识或指南和新近发表的循证医学证据，结合临床实践经验，为ICIs相关心肌炎的临床诊疗提供指导和建议。 |
| 关键词: 免疫检查点抑制剂 心肌炎 心脏毒性 免疫相关不良事件 |
| DOI：10.12025/j.issn.1008-6358.2023.20221827 |
| 分类号: |
| 基金项目:国家自然科学基金（82170359），复旦大学附属中山医院临床研究专项基金（2020ZSLC21），上海市放射与治疗（介入治疗）临床医学研究中心（19MC1910300）. |
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| Recommendations for clinical diagnosis and treatment of immune checkpoint inhibitors-associated myocarditis |
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WANG Yan1, CHEN Hui-yong2, LIN Jin-yi3,4,5, CHEN Jia-hui3,4,5, ZHOU Yu-hong1, ZHANG Ying-mei3,4,5, ZHANG Hong-wei6, ZHU Wei6, HU Jie7, ZHAO Gang3,4,5, YANG Xiang-dong8,4, DU Shi-suo9, LI Xiao-yu10, SHI Guo-ming11, CUI Jie3,4,5, WU Wei10, LI Jing10, ZHANG Chi3,4,5, WANG Cong3,4,5, LIU Rong-le3,4,5, LI Zheng12,4,5,13, WANG Chun-hui10, CHENG Lei-lei12,4,5,13, GE Jun-bo3,4,5
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1.Department of Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;2.Department of Rheumatology and Immunology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;3.Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;4.National Clinical Study Center for Radiology and Therapy, Shanghai 200032, China;5.Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China;6.Department of General Surgery, Zhongshan Hospital, Fudan University, Shanghai 200032, China;7.Department of Respiratory Medicine, Zhongshan Hospital, Fudan University, Shanghai 200032, China;8.Central Laboratory of Shanghai Institute of Cardiovascular Diseases, Shanghai 200032, China;9.Department of Radiotherapy, Zhongshan Hospital, Fudan University, Shanghai 200032, China;10.Department of Pharmacy, Zhongshan Hospital, Fudan University, Shanghai 200032, China;11.Department of Hepatic Oncology, Zhongshan Hospital, Fudan University, Shanghai 200032, China;12.Department of Cardiac Ultrasound, Zhongshan Hospital, Fudan University, Shanghai 200032, China;13.Shanghai Institute of Imaging Medicine, Shanghai 200032, China
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| Abstract: |
| At present, immune checkpoint inhibitors (ICIs) have been used in the treatment of multiple malignant tumors, which benefit for tumor patients. However, the ICIs-associated myocarditis has brought new challenges clinically. In this recommendations paper, the key clinical issues, such as risk factors, diagnosis and differential diagnosis, clinical classification and treatment, monitoring of outcomes, and restart of treatment for ICIs-associated myocarditis, were highlighted, and the practical guidance and suggestions for the diagnosis and treatment of ICIs-associated myocarditis were proposed by reference to the relevant consensuses or guidelines and newly published evidence-based evidences in China and other countries in combination with clinical experience. |
| Key words: immune checkpoint inhibitors myocarditis cardiotoxicity immune-related adverse events |
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