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PD-1/PD-L1免疫检查点抑制剂对右心室功能的影响

Effect of PD-1/PD-L1 immune checkpoint inhibitors on right ventricular function

    摘要
  • 摘要:
    目的 采用二维斑点追踪技术评估PD-1/PD-L1免疫检查点抑制剂（immune checkpoint inhibitors，ICIs）对肿瘤患者右心室功能的影响。
    方法 选择2018年6月至2020年11月在天津医科大学第二医院泌尿外科和肿瘤科住院的肿瘤患者46例，患者均未使用过ICIs，且进一步需要ICIs治疗。患者在基线（治疗前），给药后21 d（T1）、42 d（T2）、63 d（T3）、84 d（T4）、105 d（T5）、126 d（T6）分别进行经胸超声心动图检查。比较患者ICIs治疗前后左右心室的常规参数变化，并应用二维斑点追踪技术评估右心室纵向应变的变化。
    结果 与治疗前相比，治疗后三尖瓣环平面收缩期位移（15.15±3.42）mm vs（18.56±5.69）mm，P=0.000 1）缩短、右心室整体纵向应变（-15.76±3.27）%vs（-18.43±4.75）%，P=0.003 0和右心室流出道纵向应变（-11.83±3.74）%vs（-15.18±5.60）%，P=0.000 1）明显减小，多发生于T1~2期（分别为84%、62%及70%）。治疗前后，右心室基底径、右心室中段径、右心室长径、右心室面积变化百分数等指标正常。
    结论 PD-1/PD-L1抑制剂治疗后常出现右心室收缩功能下降，且下降多出现于治疗后21~42 d；应用二维斑点追踪技术及三尖瓣环平面收缩期位移可早期发现该变化。

     

    Abstract:
    Objective To evaluate the effect of PD-1/PD-L1 immune checkpoint inhibitors (ICIs) on right ventricular function in tumor patients by two-dimensional speckle tracking technique.
    Methods From June 2018 to November 2020, 46 cancer inpatients who had never used ICIs and needed further ICIs treatment in the Department of Urology and Oncology of the Second Hospital of Tianjin Medical University were selected. Transthoracic echocardiography was performed at baseline (pre-ICIs), 21 days (T1), 42 days (T2), 63 days (T3), 84 days (T4), 105 days (T5), and 126 days (T6) after administration. The changes of left and right ventricular parameters before and after treatment were compared, and the changes of right ventricular longitudinal strain were evaluated by two-dimensional speckle tracking technique.
    Results Compared with before treatment, the plane systolic excursion of tricuspid annulus was shorter (15.15±3.42 mm vs18.56±5.69 mm, P=0.000 1), right ventricular global longitudinal strain(-15.76±3.27)% vs (-18.43±4.75)%, P=0.003 1 and right ventricular outflow tract longitudinal strain(-11.83±3.74)% vs (-15.18±5.60)%, P=0.000 1) decreased significantly, and the changes mostly occurred in T1-2 phases (84%, 62%, and 70%, respectively). Before and after treatment, the right ventricular basal diameter, right ventricular middle diameter, right ventricular long diameter, right ventricular area change percentage were normal.
    Conclusions The right ventricular systolic function may decline after PD-1/PD-L1 ICIs treatment, and the decline mostly occurred at 21-42 days after the treatment; And two-dimensional speckle tracking and tricuspid annular plane systolic excursion can be used to analyze the decline of right ventricular function in the early stage.

     

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