Costache Irina-Iuliana, Petriş A
Disciplina de Medicină internă, Facultatea de Medicină, Universitatea de Medicină şi Farmacie "Gr. T. Popa" Iaşi.
Rev Med Chir Soc Med Nat Iasi. 2011 Oct-Dec;115(4):1200-7.
It is a well known fact that the antitumor agents like the anthracyclines induces a dose-related cardiotoxicity and more to add, the new agents used in the treatement of breast cancer may stimulate these cardiotoxic effects, causing in the end an increased morbidity and mortality rate by cardiovascular diseases. Cardiotoxicity caused by anthracyclines can be divided into 3 types: acute (during administration), early (several days to month following administration) and late (years to decades following exposure to anthracyclines). Mechanisms of this cardiotoxicity are very complex: myocyte damage has been attributed to the production of toxic oxygen free radicals, which cause lipid peroxidation of membranes leading to vacuolation, irreversible damage and myocyte replacement by fibrous tissue. Clinical manifestations of anthracycline cardiotoxicity are variable, depending in part upon the time course of appearence (acute, early or late). A number of risk factors for the development of anthracyclines cardiotoxicity have been identified. The strongest predictor is cumulative dose, age, concomitant administration of other chemotherapeutic agents and underlying heart disease. Approaches to reducing anthracyclines cardiotoxicity involved the use of novel infusion protocols, the development of new anthracycline compounds, the use of adjunctive agents, endomyocardial biopsy and noninvasive monitoring of cardiac function.
众所周知，像蒽环类药物这样的抗肿瘤药物会引发剂量相关的心脏毒性，更有甚者，用于治疗乳腺癌的新型药物可能会加剧这些心脏毒性作用，最终导致心血管疾病的发病率和死亡率上升。蒽环类药物引起的心脏毒性可分为3种类型：急性（给药期间）、早期（给药后数天至数月）和晚期（接触蒽环类药物数年至数十年后）。这种心脏毒性的机制非常复杂：心肌细胞损伤归因于有毒氧自由基的产生，这些自由基导致膜脂质过氧化，进而导致空泡形成、不可逆损伤以及心肌细胞被纤维组织替代。蒽环类药物心脏毒性的临床表现各不相同，部分取决于出现的时间进程（急性、早期或晚期）。已经确定了一些蒽环类药物心脏毒性发生的危险因素。最强的预测因素是累积剂量、年龄、同时使用其他化疗药物以及潜在的心脏病。降低蒽环类药物心脏毒性的方法包括使用新型输注方案、开发新的蒽环类化合物、使用辅助药物、心内膜心肌活检以及对心脏功能进行无创监测。
