克隆性造血：衰老、心血管疾病和癌症的交汇点：JACC 本周综述专题。
Clonal Hematopoiesis: Crossroads of Aging, Cardiovascular Disease, and Cancer: JACC Review Topic of the Week.
机构信息
Division of Cardiovascular Medicine, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Medicine, Memorial Sloan Kettering Cancer Center, and Weill Cornell Medical College, New York, New York.
出版信息
J Am Coll Cardiol. 2019 Jul 30;74(4):567-577. doi: 10.1016/j.jacc.2019.06.007.
A novel, common, and potent cardiovascular risk factor has recently emerged: clonal hematopoiesis of indeterminate potential (CHIP). CHIP arises from somatic mutations in hematopoietic stem cells that yield clonal progeny of mutant leukocytes in blood. Individuals with CHIP have a doubled risk of coronary heart disease and ischemic stroke, and worsened heart failure outcomes independent of traditional cardiovascular risk factors. The recognition of CHIP as a nontraditional risk factor challenges specialists in hematology/oncology and cardiovascular medicine alike. Should we screen for CHIP? If so, in whom? How should we assess cardiovascular risk in people with CHIP? How should we manage the excess cardiovascular risk in the absence of an evidence base? This review explains CHIP, explores the clinical quandaries, strives to provide reasonable recommendations for the multidisciplinary management of cardiovascular risk in individuals with CHIP, and highlights current knowledge gaps.
最近出现了一种新的、常见的、强效的心血管风险因素：未确定的潜在克隆性造血（CHIP）。CHIP 是由造血干细胞中的体细胞突变引起的，导致血液中突变白细胞的克隆后代。患有 CHIP 的个体患冠心病和缺血性中风的风险增加一倍，心力衰竭结局恶化，且独立于传统心血管风险因素。将 CHIP 识别为非传统风险因素，这对血液学/肿瘤学和心血管医学专家提出了挑战。我们是否应该筛查 CHIP？如果是，在哪些人当中筛查？我们应该如何评估患有 CHIP 的人的心血管风险？在缺乏证据基础的情况下，我们应该如何管理心血管风险的增加？本文综述了 CHIP，探讨了临床难题，努力为 CHIP 个体的心血管风险的多学科管理提供合理的建议，并强调了当前的知识空白。
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