蒽环类药物抗肿瘤治疗与室性心律失常的研究进展

Anthracyclines anti-tumor therapy and ventricular arrhythmias

蒽环类药物(Anthracyclines,ANT)是一种抗细胞有丝分裂的药物,因具有良好的抗肿瘤作用而成为乳腺癌、淋巴瘤、白血病等恶性肿瘤的基础用药,但它的使用受到剂量依赖性心脏毒性的限制,能够引起心律失常、心力衰竭、心肌损伤等心脏并发症。癌症患者因使用ANT可能导致心电活动紊乱,进而可能发生室速、室颤甚至猝死,但目前临床上对于ANT引起的室性心律失常暂无特效的预防和治疗方法。而ANT引起室性心律失常的机制可能涉及自主神经失平衡、氧化应激、线粒体损伤、铁代谢紊乱和电活动相关离子平衡紊乱等方面。本文将介绍ANT引起室性心律失常的基础研究和临床研究进展,总结临床上的常用预防和治疗方案,并结合自主神经再平衡策略,为减轻ANT致室性心律失常提供新的干预思路。

Anthracyclines are anti.mitotic drug.Because of their good anti-tumor effect,they has become the basic drug for breast cancer,lymphoma,leukemia and other malignant tumors.Although they are very effective,their use is limited by the dose-dependent cardiotoxicity and can cause cardiac complications such as arrhythmias,heart failure and myocardial damage.In the clinical use,it has been observed that the use of anthracyclines in cancer patients may cause cardiac electrical activity disturbances,which may lead to ventricular tachycardia,ventricular fibrillation and even sudden cardiac death.But there is no specific prevention and treatment method for this arrhythmia.The mechanism of anthracyclines causing ventricular arrhythmias may involve autonomic imbalance,oxidative stress,mitochondrial damage,iron metabolism disorders and electrical activity-related ion balance disorders.This article reviews the cardiotoxic effects of anthracyclines,introduce the potential mechanism research and clinical research progress of ventricular arrhythmias caused by them,summarize the commonly used clinical prevention and treatment options and combine the autonomic rebalancing strategy to reduce the anthracene-induced ventricular arrhythmias and provide new intervention ideas.