运动对化疗相关性心肌病的积极影响。

The Positive Effects of Exercise in Chemotherapy-Related Cardiomyopathy.

机构信息

Department of Medical-Surgical Sciences and Biotechnologies, Sapienza University of Rome, Corso della Repubblica 79, 04100, Latina, Italy.

Loyola University, Chicago, IL, USA.

出版信息

Adv Exp Med Biol. 2017;1000:103-129. doi: 10.1007/978-981-10-4304-8_8.

DOI:10.1007/978-981-10-4304-8_8

PMID:29098619

Abstract

Anthracyclines such as doxorubicin, daunorubicin, epirubicin, mitoxantrone and idarubicin, are powerful chemotherapeutic drugs used both in children and adult populations. Their properties made them particularly suitable for a large variety of neoplasms including breast adenocarcinoma, small cell lung cancer and acute leukemia. Early and late anthracycline-induced cardiotoxicity is a well-known phenomenon, and the incidence of heart failure in patients receiving doxorubicin is 2.2%, with a mortality rate over 60% at 2 years. Prognosis can be improved by prevention, early detection and treatment. A specific treatment for anthracycline-induced cardiotoxicity is not yet available, but non-pharmacological measures such as exercise, lifestyle changes and control of risk factors have shown a cardioprotective effect. Exercise training represents a viable non-pharmacological treatment as it increases cardiovascular reserve and endothelial function, regulates proapoptotic signaling, protects against reactive oxygen species (ROS), and decreases autophagy/lysosomal signaling. However, no current guidelines are available for prevention management in cancer patients. Pharmacological measures both for prevention and treatment are those used for heart failure (β-blockers, angiotensin-receptor blockers, angiotensin-converting enzyme inhibitors, statins, dexrazoxane and aldosteron antagonists). In this chapter, we will discuss how the evaluation, monitoring and prevention of chemotherapy-related cardiomyopathy is correlated with physical exercise.

摘要

蒽环类药物如多柔比星、柔红霉素、表柔比星、米托蒽醌和伊达比星等，是一种在儿童和成人中均使用的强效化疗药物。它们的特性使它们特别适用于多种肿瘤，包括乳腺癌、小细胞肺癌和急性白血病。早期和晚期蒽环类药物诱导的心脏毒性是一个众所周知的现象，接受多柔比星治疗的患者发生心力衰竭的发生率为 2.2%，2 年后的死亡率超过 60%。通过预防、早期发现和治疗可以改善预后。目前尚无针对蒽环类药物诱导的心脏毒性的特定治疗方法，但非药物措施，如运动、生活方式改变和控制危险因素，已显示出心脏保护作用。运动训练是一种可行的非药物治疗方法，因为它可以增加心血管储备和内皮功能，调节促凋亡信号，防止活性氧（ROS）的产生，并减少自噬/溶酶体信号。然而，目前尚无针对癌症患者的预防管理的指南。预防和治疗心力衰竭的药物措施（β受体阻滞剂、血管紧张素受体阻滞剂、血管紧张素转换酶抑制剂、他汀类药物、右雷佐生和醛固酮拮抗剂）都可以用于预防和治疗蒽环类药物诱导的心脏毒性。在本章中，我们将讨论如何将与体力活动相关的化疗相关性心肌病的评估、监测和预防与化疗相关性心肌病联系起来。