School of Kinesiology, University of Minnesota, Minneapolis, Minnesota, 55455; Department of Pediatrics, University of Minnesota Medical School, Minneapolis, Minnesota, 55455.
Pediatr Blood Cancer. 2014 Mar;61(3):532-7. doi: 10.1002/pbc.24829. Epub 2013 Oct 24.
Cancer is the leading cause of death by disease among U.S. children ages 1-14 years; however, over the last few decades there has been a dramatic increase in survival in these individuals. Although free of cancer, survivors are faced with a variety of chronic health problems including an increased risk of cardiovascular and metabolic abnormalities. The effect of cancer treatments on vascular structure and function in childhood cancer survivors (CCS) has not been examined.
Measures of carotid artery stiffness (compliance and distensibility) and thickness (IMT), brachial artery endothelial-dependent dilation (EDD), and endothelial-independent dilation (EID) were obtained from ultrasound imaging in 319 CCS (age: 14.6 ± 0.1 years; male/female: 112/96) who were >5 years from diagnosis and 208 (age: 13.6 ± 0.2 years; male/female: 171/148) siblings who had never been diagnosed with cancer. Participants were 9-18 years of age at examination.
Survivors of leukemia had lower carotid distensibility and compliance, indicating increased arterial stiffness, when compared to controls. There were no significant differences in measures of carotid stiffness or EDD in survivors of solid tumors and central nervous system (CNS) tumors compared to controls. EDD was lower in leukemia survivors than in controls, and EID was greater in survivors of CNS tumors than in controls.
These results demonstrate that early in life, CCS have arterial changes indicating increased risk for premature atherosclerosis and cardiovascular disease. Therefore, it is reasonable to advocate that efforts should be directed at monitoring and managing cardiovascular risk factors in CCS.
癌症是美国 1-14 岁儿童死亡的主要疾病原因；然而，在过去几十年中，这些人群的生存率显著提高。尽管癌症已经治愈，幸存者仍面临各种慢性健康问题，包括心血管和代谢异常的风险增加。癌症治疗对儿童癌症幸存者（CCS）血管结构和功能的影响尚未得到检查。
在 319 名 CCS（年龄：14.6 ± 0.1 岁；男性/女性：112/96）和 208 名（年龄：13.6 ± 0.2 岁；男性/女性：171/148）从未被诊断出患有癌症的兄弟姐妹中，通过超声成像获得了颈动脉僵硬（顺应性和可扩展性）和厚度（IMT）、肱动脉内皮依赖性扩张（EDD）和内皮非依赖性扩张（EID）的测量值。这些参与者在接受检查时年龄在 9-18 岁之间。
与对照组相比，白血病幸存者的颈动脉扩张性和顺应性较低，表明动脉僵硬增加。与对照组相比，实体瘤和中枢神经系统（CNS）肿瘤幸存者的颈动脉僵硬或 EDD 没有显著差异。白血病幸存者的 EDD 低于对照组，CNS 肿瘤幸存者的 EID 高于对照组。
这些结果表明，CCS 在生命早期就存在动脉变化，表明其患早发性动脉粥样硬化和心血管疾病的风险增加。因此，主张应努力监测和管理 CCS 的心血管危险因素是合理的。
