化疗所致神经病理性疼痛的病理生理机制及治疗研究进展

Research progress in pathophysiological mechanism and treatment of chemotherapy-induced neuropathic pain

化疗所致神经病理性疼痛(CINP)是癌症化疗中常见的不良反应,具有剂量依赖性,最初表现为急性疼痛综合征,若未能治愈或反复发作,可发展为慢性神经性疼痛。CINP的病理生理机制主要包括线粒体功能障碍、钙稳态变化、氧化应激、凋亡途径活化、髓鞘和非髓鞘纤维丢失、免疫系统活化以及离子通道表达活性增加等,不同种类化疗药物导致神经病理性疼痛的机制有所不同。目前尚缺乏有效的CINP防治措施,有较高认可度的治疗药物为5⁃羟色胺和去甲肾上腺素再摄取抑制剂度洛西汀。

Chemotherapy⁃induced neuropathic pain(CINP)is a common adverse reaction in cancer chemotherapy,which is dose⁃dependent.CINP initially presents as acute pain syndrome and can lead to chronic neuropathic pain if not cured or recurrent.The pathophysiological mechanisms of CINP include mito-chondrial dysfunction,calcium dyshomeostasis,oxidative stress,activation of apoptotic pathways,loss of myelin and non⁃myelin fibers,activation of the immune system,and increased expression of ion channels,etc.The mechanism of neuropathic pain induced by different chemotherapeutic drugs is different.There is a lack of effective CINP control measures and the highly recognized therapeutic drug is serotonin and norepinephrine reuptake inhibitor duloxetine.