Clinical Research Division, Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N,Seattle, WA 98109, USA.
Bone Marrow Transplant. 2012 May;47(5):619-25. doi: 10.1038/bmt.2011.118. Epub 2011 Jun 6.
Increasing numbers of hematopoietic cell transplantations (HCTs) are being performed annually with a greater number of long-term survivors. There is increasing concern regarding the late complications and long-term effects that are secondary to treatment exposures before HCT as well as during the HCT conditioning therapy. In both the autologous as well as allogeneic transplant setting, transplant survivors experience mortality rates higher than the general population and the risk of premature cardiovascular (CV)-related death is increased 2.3-fold compared with the general population. The etiology of CV-related deaths in HCT survivors is multifactorial; however, increasing evidence suggests that HCT survivors are at higher risk of developing adverse CV risk factors leading to the development of the metabolic syndrome (a constellation high triglyceride levels, low high-density lipoprotein-cholesterol, hypertension, high fasting blood sugars and increased waist circumference), which then predisposes individuals to risk for early CV-related death. Resistance to insulin is the primary underlying pathophysiologic mechanism that contributes to the development of metabolic syndrome and HCT survivors have been shown to be more likely to develop hypertension, hyperlipidemia and to be insulin resistant. However, the relationship between HCT-related treatment exposures (total body irradiation, high dose chemotherapy, calcineurin inhibitors, steroids, etc) and transplant-related complications (such as GVHD) with the development of CV risk factors and insulin resistance is still in the early stages of investigation. Greater knowledge of the concern regarding CV risk in HCT survivors among both patients and care providers will provide the opportunity for appropriate screening as well as interventions for modifiable risk factors.
每年进行的造血细胞移植（HCT）数量不断增加，长期存活者也越来越多。人们越来越关注 HCT 前和 HCT 调理治疗期间因治疗暴露而导致的迟发性并发症和长期影响。在自体和同种异体移植环境中，移植幸存者的死亡率高于一般人群，与一般人群相比，心血管（CV）相关死亡的风险增加了 2.3 倍。HCT 幸存者 CV 相关死亡的病因是多因素的；然而，越来越多的证据表明，HCT 幸存者发生不良 CV 危险因素的风险更高，导致代谢综合征（一组高甘油三酯水平、低高密度脂蛋白胆固醇、高血压、高空腹血糖和增加的腰围）的发展，从而使个体易发生早期 CV 相关死亡。胰岛素抵抗是导致代谢综合征发展的主要潜在病理生理机制，HCT 幸存者更有可能发生高血压、高血脂和胰岛素抵抗。然而，HCT 相关治疗暴露（全身照射、高剂量化疗、钙调神经磷酸酶抑制剂、类固醇等）与移植相关并发症（如 GVHD）与 CV 危险因素和胰岛素抵抗的发展之间的关系仍处于研究的早期阶段。更多地了解患者和护理提供者对 HCT 幸存者 CV 风险的关注，将为可改变的危险因素提供适当的筛查和干预机会。
