应重视免疫检查点抑制剂相关心血管不良反应中的科学问题

Call for attention to the scientific issues in cardiovascular adverse effects associated with immune checkpoint inhibitors

心血管疾病(CVD)和癌症是两种密切相关的疾病,它们的发生具有共同的危险因素以及遗传和分子机制,是全球最主要的死亡原因。近年来,随着诊疗的进步,癌症患者生存期不断延长,癌症患者因抗癌治疗诱发的心血管死亡风险显著高于一般人群。鉴于心血管毒性的普遍性和严重性,心脏病学临床分支“肿瘤心脏病学”应运而生。免疫检查点抑制剂(ICIs)已被广泛用于治疗各类癌症,但其导致多种心血管毒性,其中心肌炎发病率为0.04%~2.4%,死亡率更高达25%~50%。然而,人们对ICIs诱发心血管毒性的分子和病理生理机制知之甚少。因此,本文结合近期ICIs诱发心血管毒性的研究成果,探讨其发病机制、诊断、监测和治疗方法,从而预防心血管损伤,改善心脏功能。

Cardiovascular disease(CVD)and cancer are two intimately interconnected conditions with leading causes of mortality worldwide.Emerging evidence suggests that CVD and cancer have common risk factors and share genetics and molecular mechanisms.With recent advancements in diagnosis and treatment,the number of long-term survivors have been continuously increasing.However,cancer patients have significantly higher cardiovascular mortality than general population,mostly resulting from cardiotoxic side effects of anticancer treatments.The prevalence and severity of cardiotoxicity and vascular abnormalities led to the emergence of a clinical branch of cardiology,known as cardio-oncology.Immune checkpoint inhibitors(ICIs)are currently widely used for treatment of various types of cancers.Recent studies suggest that ICIs lead to cardiotoxicity including myocarditis with an incidence of 0.04%-2.4%and a mortality of 25%-50%.However,the molecular and pathophysiologic mechanisms underlying the cardiovascular toxicity induced by ICIs are poorly understood.Therefore,this article combines the recent research results of the pathophysiology of cardiovascular toxicity induced by ICIs and explores novel diagnostic,monitoring,and therapeutic approaches to improve cardiac function and prevent cardiovascular injury.