目的 探討阿替利珠單抗相關(guān)心臟不良反應的臨床特點、發(fā)生規(guī)律、治療效果及轉(zhuǎn)歸，為臨床合理用藥及心臟不良反應的防治提供依據(jù)。方法 檢索中國知網(wǎng)、萬方數(shù)據(jù)庫、維普網(wǎng)、中國生物醫(yī)學文獻服務(wù)系統(tǒng)、PubMed、Web of Science數(shù)據(jù)庫，收集自建庫至2025年3月發(fā)表的阿替利珠單抗相關(guān)心臟不良反應案例報道文獻，對符合要求的病例臨床資料進行統(tǒng)計和分析。結(jié)果 共納入35篇文獻，涉及36名患者，男女比例約2∶1；60歲以上患者居多；原患疾病以肺癌為主，合并心臟基礎(chǔ)疾病和高血壓的患者較多；不良反應以心肌炎多見，少數(shù)患者出現(xiàn)說明書未注明的新的不良反應；不良反應發(fā)生時間多在用藥1個周期后；86.11%患者有明顯臨床癥狀，癥狀常見為呼吸困難，15例患者伴隨其他系統(tǒng)不良反應和相應臨床癥狀；實驗室檢查多見肌鈣蛋白I、腦利鈉肽、肌酸激酶等心臟生物標記物的升高；心電圖檢查以傳導阻滯、ST段異常、心動過速較常見；超聲心動圖多見射血分數(shù)降低、左心室壁運動減弱、心包積液；冠狀動脈造影基本正常；心臟核磁共振多見心室壁運動異常，病理學多見混合型炎性細胞浸潤；經(jīng)停藥、手術(shù)、糖皮質(zhì)激素及其他對癥支持治療后，部分患者心臟功能恢復，大于1/3的患者死亡。結(jié)論 阿替利珠單抗相關(guān)心臟不良反應不容忽視，臨床醫(yī)生應加強對使用該藥物患者的心臟監(jiān)測，早期識別和干預心臟不良反應，以改善患者預后。

Objective To analyze the clinical characteristics, occurrence patterns, treatment effects, and outcomes of cardiac adverse reactions associated with atezolizumab, providing a basis for rational clinical drug use and the prevention and treatment of cardiac adverse reactions. Methods Databases such as CNKI, Wanfang Database, VIP Database, Chinese Biomedical Literature Service System, PubMed, and Web of Science were searched to collect literature on case reports of cardiac adverse reactions related to atezolizumab published from the establishment of the databases to March 2025. The clinical data of eligible cases were statistically analyzed. Results A total of 35 articles were included, involving 36 patients, with male and female ratio of approximately 2:1. Most patients were over 60 years old. Lung cancer was the primary underlying disease, and many patients had underlying heart diseases and hypertension. Myocarditis was the most common adverse reaction, and a few patients developed new adverse reactions not noted in the drug instructions. The adverse reactions mostly occurred after one cycle of medication. 86.11% of the patients had obvious clinical symptoms, with dyspnea being the most common. 15 patients had adverse reactions in other systems and corresponding clinical symptoms. Laboratory tests often showed increased cardiac biomarkers such as troponin I, brain natriuretic peptide, and creatine kinase. Electrocardiogram examinations commonly showed conduction block, ST - segment abnormalities, and tachycardia. Echocardiograms often showed reduced ejection fraction, weakened left ventricular wall motion, and pericardial effusion. Coronary angiography was basically normal. Cardiac magnetic resonance imaging often showed abnormal ventricular wall motion, and pathology often showed mixed inflammatory cell infiltration. After drug withdrawal, surgery, glucocorticoid treatment, and other symptomatic and supportive treatments, the cardiac function of some patients recovered, and more than 1/3 of the patients died. Conclusion Cardiac adverse reactions associated with atezolizumab cannot be ignored. Clinicians should strengthen cardiac monitoring of patients taking this drug, identify and intervene in cardiac adverse reactions at an early stage to improve the prognosis of patients.

R979.1

天津市衛(wèi)生健康科技項目資助項目（TJWJ2024MS062）