Brestescher C, Pautier P, Farge D
Service de Médecine Interne et Pathologie Vasculaire, Hôpital Saint-Louis, Paris.
Ann Cardiol Angeiol (Paris). 1995 Oct;44(8):443-7.
Among the various anticancer drugs, used alone or in combination during courses of chemotherapy, anthracyclines (leader: doxorubicin) are responsible for direct myocardial toxicity, which can exceptionally be acute, but more often chronic with a delayed onset. This cardiotoxicity is directly proportional to the cumulative dose administered and the recommended total dose for doxorubicin is 550 mg/m2. The risk factors able to potentiate cardiotoxicity must be analysed before starting chemotherapy and follow-up by ultrasonography and/or isotope ejection fraction must be repeated before each course. The treatment of anthracycline-induced heart failure consists of digitalis alkaloids combined with angiotensin converting enzyme inhibitors. The cardiac toxicity of 5FU is currently explained by the theory of coronary spasm, based on clinical findings such as chest pain associated with ischaemic electrical modifications. The incidence of this toxicity is low, but it can be fatal. Exceptional examples include the cardiotoxicity induced by high-dose cyclophosphamide responsible for acute haemorrhagic myocarditis, potentiation of the cardiotoxic effect of anthracyclines by dacarbazine and plicamycin, and serious ventricular and supraventricular arrhythmias induced by amsacrine. Among the various cytokines used in oncology, interferon is responsible for heart failure, reversible after stopping treatment, but also for ventricular arrhythmias, or even sudden death, the pathophysiology of which still remains unclear.
在化疗过程中单独或联合使用的各种抗癌药物中，蒽环类药物（以阿霉素为首）会导致直接的心肌毒性，这种毒性极少情况下是急性的，但更常见的是慢性的且起病延迟。这种心脏毒性与给药的累积剂量成正比，阿霉素的推荐总剂量为550mg/m²。在开始化疗前必须分析可能增强心脏毒性的危险因素，并且在每个疗程前都必须重复通过超声心动图和/或同位素射血分数进行随访。蒽环类药物所致心力衰竭的治疗包括洋地黄生物碱联合血管紧张素转换酶抑制剂。5-氟尿嘧啶的心脏毒性目前根据冠状动脉痉挛理论来解释，其依据是诸如伴有缺血性电改变的胸痛等临床发现。这种毒性的发生率较低，但可能致命。特殊例子包括高剂量环磷酰胺所致的心脏毒性，可导致急性出血性心肌炎；达卡巴嗪和普卡霉素增强蒽环类药物的心脏毒性作用；以及安吖啶所致的严重室性和室上性心律失常。在肿瘤学中使用的各种细胞因子中，干扰素会导致心力衰竭，停药后可逆转，但也会导致室性心律失常，甚至猝死，其病理生理学仍不清楚。
