aDepartment of Pediatrics, Wayne State University School of Medicine and Children's Hospital of Michigan, Detroit, Michigan bDepartment of Pediatrics, University of Miami Miller School of Medicine cHoltz Children's Hospital of the Jackson Health System, Miami, Florida, USA.
Curr Opin Cardiol. 2014 Jan;29(1):103-12. doi: 10.1097/HCO.0000000000000034.
Anthracyclines have markedly improved the survival rates of children with cancer. However, anthracycline-related cardiotoxicity is also well recognized and can compromise the long-term outcome in some patients. The challenge remains of how to balance the chemotherapeutic effects of anthracycline treatment with its potentially serious cardiovascular complications. Here, we review the pathophysiology, risk factors, clinical manifestations, prevention, and treatment of anthracycline-related cardiotoxicity.
Some risk factors and biomarkers associated with an increased probability of anthracycline-related cardiotoxicity have been identified. Modifying the structural forms and dosages of anthracyclines and coadministering cardioprotective agents may prevent some of these cardiotoxic effects. Cardiovascular complications have also been treated with angiotensin-converting enzyme inhibitors, β-blockers, and growth hormone replacement therapy. Cardiac transplantation remains the treatment of last resort.
Despite major advances in cancer treatment, anthracycline-related cardiotoxicity remains a major cause of morbidity and mortality in survivors of childhood cancer. Promising areas of research include: use of biomarkers for early recognition of cardiac injury in children receiving chemotherapy, development and application of cardioprotective agents for prevention of cardiotoxicity, and advancements in therapies for cardiac dysfunction in children after anthracycline treatment.
蒽环类药物显著提高了儿童癌症患者的生存率。然而，蒽环类药物相关的心脏毒性也得到了广泛认可，在某些患者中可能会影响长期预后。如何平衡蒽环类药物治疗的化疗效果及其潜在的严重心血管并发症仍然是一个挑战。本文综述了蒽环类药物相关心脏毒性的病理生理学、危险因素、临床表现、预防和治疗。
已经确定了一些与蒽环类药物相关心脏毒性概率增加相关的危险因素和生物标志物。改变蒽环类药物的结构形式和剂量，并联合使用心脏保护剂可能会预防其中一些心脏毒性作用。还可以使用血管紧张素转换酶抑制剂、β受体阻滞剂和生长激素替代疗法来治疗心血管并发症。心脏移植仍然是最后的治疗手段。
尽管癌症治疗取得了重大进展，但蒽环类药物相关心脏毒性仍然是儿童癌症幸存者发病率和死亡率的主要原因。有前途的研究领域包括：使用生物标志物早期识别接受化疗的儿童的心脏损伤，开发和应用心脏保护剂预防心脏毒性，以及推进蒽环类药物治疗后儿童心脏功能障碍的治疗。
