生物标志物对免疫检查点抑制剂相关心肌炎患者激素抵抗及预后的预测价值

王尹曼; 蔡青青; 王妍; 刘媛; 吕迁洲; 程蕾蕾

doi:10.12025/j.issn.1008-6358.2026.20260423

生物标志物对免疫检查点抑制剂相关心肌炎患者激素抵抗及预后的预测价值

Predictive value of biomarkers for steroid resistance and prognosis in patients with immune checkpoint inhibitor-associated myocarditis

摘要

摘要:
目的探讨血清标志物可溶性生长刺激表达基因2蛋白（soluble growth stimulation expressed gene 2 protein, sST2）、心肌肌钙蛋白T（cardiac troponin T, cTnT）、肌酸激酶同工酶（creatine kinase-myocardial band, CK-MB）预测免疫检查点抑制剂相关心肌炎（immune checkpoint inhibitor-associated myocarditis, ICIAM）患者激素抵抗及预后的预测价值。
方法前瞻性纳入2023年3月至2024年2月在复旦大学附属中山医院诊治的28例ICIAM患者，分为激素抵抗型ICIAM（steroid-resistant ICIAM, srICIAM）组与非srICIAM组。检测患者治疗前sST2、cTnT、CK-MB水平，通过ROC曲线分析预测srICIAM的效能。通过Kaplan-Meier法评估sST2与全因死亡率的关系。
结果 srICIAM组（n＝15）基线sST2、cTnT、CK-MB 水平较非srICIAM组（n＝13）升高（P＜0.05）。cTnT联合sST2预测srICIAM的效能最优（AUC＝0.857，灵敏度0.714、特异度 1.000）。随访6个月时，高sST2组全因死亡率高于低sST2组（P＝0.016）。
结论 sST2联合cTnT可有效预测srICIAM；高sST2与ICIAM患者的全因死亡率升高相关，能为早期风险分层与治疗优化提供依据。

Abstract:
Objective To investigate predictive value of soluble growth stimulation-expressed gene 2 protein (sST2), cardiac troponin T (cTnT), and creatine kinase-myocardial band (CK-MB) for steroid resistance and prognosis in patients with immune checkpoint inhibitor-associated myocarditis (ICIAM).
Methods A total of 28 patients with ICIAM were prospectively enrolled from March 2023 to February 2024 at Zhongshan Hospital, Fudan University. All participants were divided into the steroid-resistant ICIAM (srICIAM) group and the non-srICIAM group. Baseline serum levels of sST2, cTnT and CK-MB were detected prior to treatment initiation. ROC curve analysis was applied to evaluate the predictive value of these biomarkers, and Kaplan-Meier survival analysis was performed to explore the relationship between sST2 and all-cause mortality.
Results Baseline sST2, cTnT, and CK-MB levels were significantly higher in the srICIAM group (n＝15) than in the non-srICIAM group (n＝13, P＜0.05). Combination of cTnT and sST2 improved predictive performance for srICIAM (AUC＝0.857, sensitivity 0.714, specificity 1.000). After 6 months of follow-up, the high sST2 group had a significantly higher all-cause mortality than the low sST2 group (P＝0.016).
Conclusions The combination of sST2 and cTnT could effectively predict srICIAM, and elevated sST2 is associated with increased higher all-cause mortality in ICIAM patients, providing a basis for early risk stratification and treatment optimization.

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