肿瘤恶液质相关心脏萎缩临床诊治进展

Progress in Clinical Diagnosis and Treatment of Cancer-related Cardiac Atrophy

近年来,全球恶性肿瘤患者数量急剧上升,肿瘤恶液质及其相关并发症造成的医疗、经济负担也在剧增。肿瘤恶液质是一种复杂的多因素综合征,它的主要特点是骨骼肌进行性丢失,并与多器官功能障碍相关,靠常规的营养治疗手段不能完全逆转。肿瘤恶液质相关心脏并发症,包括心脏萎缩、重塑、功能障碍,甚至心力衰竭。肿瘤恶液质相关心脏萎缩,主要是由于恶液质介质和泛素蛋白酶体途径之间相互作用的结果。蛋白生成抑制引发心肌萎缩,泛素—蛋白酶体系统(UPS)激活降低心肌蛋白质合成,炎症状态加速心肌萎缩过程,胰岛素抵抗导致储存蛋白消耗,并阻碍组织细胞对营养物质的摄取利用。肿瘤恶液质相关心脏萎缩是肿瘤恶液质患者心血管系统的早期并发症,经常被临床忽视,或将其与心脏原发病混淆。未及时诊治心脏萎缩,不仅会加重肿瘤恶液质,也会降低抗肿瘤治疗疗效,因此,对肿瘤恶液质相关心脏萎缩进行科学诊治,可以帮助提升抗肿瘤治疗疗效,进而提高肿瘤患者生存率。因此,肿瘤恶液质相关心脏萎缩的早期筛查、诊断和治疗,对肿瘤治疗有重要意义。

In recent years,the number of cancer patients in the world has risen sharply,and the medical and economic burden caused by cancer cachexia and its related complications has also increased dramatically.Cancer cachexia is a complex multifactorial syndrome characterized by progressive loss of skeletal muscle and associated with multiple organ dysfunction,which could not be completely reversed by conventional nutritional therapy.Cardiac complications associated with cancer cachexia include cardiac atrophy,remodeling,dysfunction,and even heart failure.Cancer cachexia-induced cardiac atrophy,is mainly as a result of interactions between cachexia mediators and the ubiquitin-proteasome pathway.Activation of the ubiquitin-proteasome system(UPS)decreases cardiac protein synthesis,and inflammation accelerates the process of myocardial atrophy,at the same time insulin resistance leads to the depletion of stored proteins and hinders the uptake and utilization of nutrients by tissues and cells.It is an early complication of the cardiovascular system in patients with cancer cachexia,which is often ignored or confused with the primary heart disease.Failure to diagnosis and treatment cardiac atrophy in time will not only aggravate severe cachexia,but also reduce the curative effect of anti-cancer treatment.Therefore,scientific diagnosis and treatment of cancer related cardiac atrophy can help improve the curative effect of anti-cancer treatment,and thus improve the survival rate of cancer patients.Therefore,the early screening,diagnosis and treatment of cancerous cachexia related cardiac atrophy is of great significance for tumor treatment.