放射性心血管疾病的研究进展

Research progress of radiation-induced cardiovascular diseases

随着治疗手段的不断发展和提高,恶性肿瘤患者的生存时间得到了显著延长,然而与综合治疗相关的迟发不良反应也日益增加。对胸部恶性肿瘤的放射治疗不可避免地导致心脏受照。放疗诱导的微血管缺血导致毛细血管内皮结构的破坏,同时心肌细胞的损伤导致胶原蛋白和纤维化的沉积。放疗不仅造成心脏损伤,还会加速合并代谢综合征和动脉粥样硬化患者主要冠脉事件的发生。因此,了解放疗诱发的心血管疾病的潜在病理生理学机制及其临床表现,对制定合理的放射性心血管疾病的预防和监测措施具有重大意义。

Cancer survival has improved dramatically,but this has also increased the delayed side effects of multimodality therapy. Radiation（ RT） to the thoracic malignancies results in unintentional irradiation of the cardiac chambers. RT-induced microvascular ischemia leads to disruption of capillary endothelial framework,and injury to differentiated myocytes results in deposition of collagen and fibrosis. Radiotherapy not only causes heart damage,but also accelerates the occurrence of major coronary events in patients with metabolic syndrome and atherosclerosis. Hence,it becomes pertinent to understand the underlying pathophysiology and clinical manifestations of RT-induced cardiovascular disease to devise optimal preventive and surveillance strategies.