Oeffinger Kevin C
Department of Pediatrics, Memorial Sloan-Kettering Cancer Center, New York, New York, USA.
Pediatr Blood Cancer. 2008 Feb;50(2 Suppl):462-7; discussion 468. doi: 10.1002/pbc.21410.
Through a variety of different mechanisms, it appears that survivors of childhood acute lymphoblastic leukemia have an increased prevalence of several cardiovascular risk factors and thus are at increased risk for developing cardiovascular disease. The aim of this paper is to describe the current understanding of particular risk factors, including obesity, physical inactivity, dyslipidemia, insulin resistance, and metabolic syndrome, that may contribute to cardiovascular disease in survivors of childhood ALL. The potential roles of different cancer therapies in the development of these risk factors are discussed. In addition, two other late effects that may affect cardiovascular health are discussed: late-onset anthracycline-induced left ventricular dysfunction and methotrexate-mediated elevations of homocysteine during therapy with the potential for endothelial dysfunction. Lastly, areas needing further investigation to elucidate these risks are highlighted.
通过多种不同机制，儿童急性淋巴细胞白血病幸存者似乎存在多种心血管危险因素，因此患心血管疾病的风险增加。本文旨在描述对特定危险因素的当前认识，包括肥胖、身体活动不足、血脂异常、胰岛素抵抗和代谢综合征，这些因素可能导致儿童急性淋巴细胞白血病幸存者患心血管疾病。讨论了不同癌症治疗方法在这些危险因素发展过程中的潜在作用。此外，还讨论了可能影响心血管健康的另外两种晚期效应：迟发性蒽环类药物诱导的左心室功能障碍以及甲氨蝶呤在治疗期间介导的同型半胱氨酸升高，这可能导致内皮功能障碍。最后，强调了需要进一步研究以阐明这些风险的领域。
