Grenier M A, Lipshultz S E
Division of Pediatric Cardiology, University of Rochester Medical Center, Children's Hospital at Strong, Strong Children's Research Center, Rochester, NY 14642, USA.
Semin Oncol. 1998 Aug;25(4 Suppl 10):72-85.
Anthracyclines, potent cytotoxic agents used to treat a broad spectrum of malignancies, are limited in their use by an attendant risk of cardiotoxicity. Malignancies affect all age ranges, and anthracyclines are used in all age ranges, thereby exposing a broad population of patients to the development of heart disease. For some treated patients, anthracyclines affect cardiac muscle, resulting in cardiomyopathy. The type and degree of cardiomyopathy, as well as when during or after treatment the condition occurs, are dependent on what risk factors are present. Age is a major risk factor. Children and adults may develop restrictive and dilated cardiomyopathy. The length of subsequent survival and amount of subsequent somatic growth may influence late anthracycline-associated cardiac outcome. Early cardiotoxicity, occurring during or within 1 year of completion of treatment, is the largest risk factor for the development of late cardiotoxicity, which occurs beyond a year of completion of treatment. Risk factors, which appear to be specific for early cardiotoxicity in children, include black race, trisomy 21, and the use of amsacrine therapy after anthracycline therapy. More cardiotoxic effects are seen in survivors of childhood cancer, the longer from completion of treatment a patient is followed. Cumulative as well as peak anthracycline doses affect adults and children alike, and cardiotoxicity occurs early and late. In adults, left ventricular contractility is affected by anthracyclines. Children may manifest impairment of left ventricular contractility and increased afterload due to thinning of left ventricular walls. Patients with an early presentation of depressed left ventricular contractility are likely to show progression of cardiac disease with time. In addition, female gender appears to affect early and late cardiotoxicity in both adults and children, although this risk factor has been described predominantly in the survivors of childhood cancer. Thus, although anthracycline chemotherapy has improved overall survivorship of patients with cancer, there is a significant risk of cardiotoxicity associated with this class of drugs.
蒽环类药物是用于治疗多种恶性肿瘤的强效细胞毒性药物，但因其伴随的心脏毒性风险而在使用上受到限制。恶性肿瘤影响所有年龄段，蒽环类药物也用于所有年龄段，从而使广大患者群体面临患心脏病的风险。对于一些接受治疗的患者，蒽环类药物会影响心肌，导致心肌病。心肌病的类型和程度，以及在治疗期间或治疗后何时发生这种情况，取决于存在哪些风险因素。年龄是一个主要风险因素。儿童和成人可能会发展为限制性和扩张性心肌病。后续生存时间和后续身体生长量可能会影响晚期蒽环类药物相关的心脏结局。早期心脏毒性发生在治疗期间或治疗完成后1年内，是发生在治疗完成1年后的晚期心脏毒性发展的最大风险因素。似乎是儿童早期心脏毒性特有的风险因素包括黑人种族、21三体综合征以及蒽环类药物治疗后使用安吖啶治疗。儿童癌症幸存者随访时间越长，心脏毒性作用越明显。蒽环类药物的累积剂量和峰值剂量对成人和儿童都有影响，心脏毒性在早期和晚期都会发生。在成人中，蒽环类药物会影响左心室收缩力。儿童可能会因左心室壁变薄而出现左心室收缩力受损和后负荷增加。早期出现左心室收缩力降低的患者很可能随着时间的推移出现心脏病进展。此外，女性性别似乎会影响成人和儿童的早期和晚期心脏毒性，尽管这个风险因素主要在儿童癌症幸存者中有所描述。因此，尽管蒽环类药物化疗提高了癌症患者的总体生存率，但这类药物存在显著的心脏毒性风险。
