[癌症及抗癌治疗的心血管并发症]
[Cardiovascular complications of cancers and anti-cancer therapy].
作者信息
Vyskočil Jiří, Petráková Katarína, Jelínek Petr, Furdek Michal
出版信息
Vnitr Lek. 2017 Spring;63(3):200-209.
In our aging population the incidence of cancer is increasing in the elderly. We are thus facing a new challenge especially considering incidence of cardiovascular diseases (CVD) in this patients population. Overall survival of cancer patients has significantly improved therefore cancer has become in many cases a chronic disease. We are about to be treating patients who either may develop a new CVD or their current CVD may deteriorate. Cancer can cause various cardiovascular conditions locally (pressure in mediastinum, effusions) or systemically (increased risk of pulmonary embolism, arrhythmias, carcinoid heart disease). Medical cancer therapy can lead to congestive heart failure (CHF) per se, by anthracycline or antiHER2 therapy direct cardiac toxicity or by number of other cardiac conditions medical treatment can cause, such as accelerated arterial hypertension due to anti-angiogenic therapy (tyrosine-kinase inhibitors, bevacizumab) or even standard chemotherapy (alkylating agents, cisplatin) or overusing steroids in cancer patients. Atrial fibrillation (AFib) also contributes to CHF development. AFib in cancer patients may develop secondary to ischaemia in anaemic patients, metabolic disorders caused by cancer or treatment, pulmonary embolism, sepsis or even as a result of direct impact of cytotoxic treatment (cisplatin, ifosfamide, gemcitabine, 5-fluorouracil, etoposide). One of major risk factors for CHF is coronary artery disease (CAD), which is a very serious late sequel of cancer therapy mainly in long time cancer survivors (testicular cancer, childhood cancer, hematologic malignancies, breast cancer). CAD may develop secondary to thoracic irradiation, dyslipidemia caused by hormonal treatment or simply as results of endothelial dysfunction caused by alkylating agents. In summary, long time cancer survivors represent a subgroup of patients at great risk of developing CVD in any form. It is crucial to mention that these patients can develop typical CVD much earlier compared to standard population and therefore require special follow-up with active surveillance.Key words: anthracycline - atrial fibrillation - cardiac toxicity - heart failure - pulmonary embolism.
在老龄化人口中,老年人患癌症的发病率正在上升。因此,我们正面临着一项新的挑战,尤其是考虑到这一患者群体中心血管疾病(CVD)的发病率。癌症患者的总体生存率有了显著提高,因此在许多情况下癌症已成为一种慢性病。我们即将治疗那些可能会患上新的心血管疾病或其现有心血管疾病可能恶化的患者。癌症可局部(纵隔受压、积液)或全身(肺栓塞、心律失常、类癌性心脏病风险增加)导致各种心血管疾病。癌症医学治疗本身可导致充血性心力衰竭(CHF),如蒽环类药物或抗HER2治疗导致的直接心脏毒性,或因其他多种心脏疾病导致的医学治疗,如抗血管生成治疗(酪氨酸激酶抑制剂、贝伐单抗)导致的加速性动脉高血压,甚至标准化疗(烷化剂、顺铂)或癌症患者过度使用类固醇。心房颤动(AFib)也会导致CHF的发生。癌症患者的AFib可能继发于贫血患者的缺血、癌症或治疗引起的代谢紊乱、肺栓塞、败血症,甚至是细胞毒性治疗(顺铂、异环磷酰胺、吉西他滨、5-氟尿嘧啶、依托泊苷)的直接影响。CHF的主要危险因素之一是冠状动脉疾病(CAD),这是癌症治疗非常严重的晚期后遗症,主要发生在长期癌症幸存者(睾丸癌、儿童癌症、血液系统恶性肿瘤、乳腺癌)中。CAD可能继发于胸部放疗、激素治疗引起的血脂异常,或仅仅是烷化剂引起的内皮功能障碍的结果。总之,长期癌症幸存者是患任何形式心血管疾病风险极高的患者亚组。必须提到的是,与普通人群相比,这些患者可能更早地患上典型的心血管疾病,因此需要进行特殊的随访和积极监测。关键词:蒽环类药物 - 心房颤动 - 心脏毒性 - 心力衰竭 - 肺栓塞