Nursing and Rehabilitation Practice of One Case of Immunotherapy-Related Myocarditis and Dermatitis Induced by Serplulimab
1例斯鲁利单抗致免疫相关性心肌炎及皮炎的护理与康复实践

摘要

斯鲁利单抗是一种程序性死亡受体1（programmed death pro-tein-1, PD-1）单抗，在多种恶性肿瘤治疗中展现出较好疗效。然而，随着免疫治疗的广泛应用，免疫相关性不良反应（irAEs）的发生逐渐受到关注，这些不良反应可累及全身多个系统，严重影响患者的治疗进程和生活质量^[1-3]。斯鲁利单抗通过阻断PD-1与其配体PD-L1和PD-L2的结合，激活T淋巴细胞，增强机体对肿瘤细胞的免疫应答，从而发挥抗肿瘤作用^[4]。斯鲁利单抗作为 PD-1 抑制剂，其不良反应主要涉及免疫相关不良反应，如免疫相关性心肌炎、免疫相关性皮炎等。免疫相关性心肌炎可表现为乏力、肌肉酸痛、胸闷、心悸等；免疫相关性皮炎表现为躯干、四肢对称性分布的红色斑疹或丘疹，可伴随瘙痒，部分融合成片，严重时可累及面部、手足，严重者可出现大面积水疱。我院于2025年6月收治了一例使用斯鲁利单抗发生免疫相关性心肌炎、皮炎不良反应，经由多学科团队参与诊疗，给予对症用药及皮肤护理后，患者病情明显改善,现将临床护理体会报道如下。

Abstract

Serplulimab is a programmed death protein-1 (PD-1) monoclonal antibody that has demonstrated favorable efficacy in the treatment of various malignant tumors. However, with the widespread application of immunotherapy, immune-related adverse events (irAEs) have gradually attracted attention, as these adverse events can involve multiple systems of the body and significantly impact patients 'treatment progress and quality of life ^[1-3]. Serplulimab exerts its antitumor effects by blocking the binding of PD-1 to its ligands PD-L1 and PD-L2, thereby activating T lymphocytes and enhancing the immune response against tumor cells^[4]As a PD-1 inhibitor, the adverse reactions of serplulimab primarily involve immune-related adverse events, such as immune-associated myocarditis and immune-associated dermatitis. Immune-associated myocarditis may manifest as fatigue, myalgia, chest tightness, and palpitations; immune-associated dermatitis presents as symmetrical erythematous macules or papules on the trunk and extremities, often accompanied by pruritus, which may coalesce into larger patches and, in severe cases, involve the face, hands, and feet, or even lead to extensive blistering. In June 2025, our hospital admitted a patient who developed immune-associated myocarditis and dermatitis as adverse reactions to serplulimab. Through multidisciplinary team involvement in diagnosis and treatment, symptomatic medication and skin care were administered, resulting in significant improvement in the patient's condition. The clinical nursing experience is reported as follows.