心力衰竭与癌症发生发展研究进展

Progress in the research on the occurrence and development of heart failure and cancer

从心力衰竭与癌症的共同发病机制、心力衰竭促进癌症的临床前研究及临床研究等几方面回顾文献并进行论述,以提高对心力衰竭患者后续新发癌症或癌症进展的警惕,并进行早期干预。利用中国知网中文数据库,以“慢性心力衰竭”“肿瘤”“癌症”为关键词,检索2018-12-01至2023-12-31相关文献。利用PubMed英文数据库,以“chronic heart failure”“tumor”“cancer”为关键词,检索2018-12-01至2023-12-31相关文献。纳入标准:(1)心力衰竭与癌症的共同发病机制;(2)心力衰竭促进癌症发生发展的基础研究;(3)心力衰竭促进癌症发生发展的临床研究。剔除标准:(1)心血管疾病的病因、诊治与预后;(2)年份较远的综述类文献;(3)质量较差、语言结构混乱的文献。符合要求纳入分析共45篇文献。结果表明,心力衰竭与癌症有着诸多共同的危险因素,包括高血压、糖尿病、肥胖、性别差异和不良生活习惯如吸烟等。关于心力衰竭与癌症的共同发病率增高,一种观点认为是由于两者具有共同的致病机制,包括炎症反应假说、氧化应激假说、代谢重构假说、微生物群系假说、克隆性造血假说、细胞外基质假说、血管生成假说以及神经激素假说等。而另一种观点则认为心力衰竭促进了癌症的发生发展,通过临床前研究发现心力衰竭小鼠模型中,心脏分泌某种因子,可以促进部分癌症的发生发展,并有越来越多的临床研究数据表明心力衰竭患者罹患癌症的风险更高,且这可能与性别有关,而与年龄的相关性较弱。提示,在癌症的高危人群或患癌人群中,实施降低心血管疾病风险的策略,不仅可以降低心血管的发病率,也可以有效降低癌症的死亡率。

This review examines the literature in various aspects,including the common pathogenesis of heart failure and cancer,preclinical and clinical studies on how heart failure promotes cancer,aiming to raise awareness of the potential development of new cancers or cancer progression in patients with heart failure and to advocate for early intervention.Using the Chinese National Knowledge Infrastructure(CNKI)database,literature related to"chronic heart failure""tumor,"and"cancer"was retrieved with a time frame from December 1,2018,to December 31,2023.Similarly,using the PubMed English database,literature with keywords"chronic heart failure""tumor"and"cancer"was retrieved for the same period.Inclusion criteria comprised:(1)the common pathogenesis of heart failure and cancer,(2)basic research on how heart failure promotes cancer occurrence and development,and(3)clinical studies on the relationship between heart failure and cancer.Exclusion criteria included(1)etiology,diagnosis,and prognosis of cardiovascular diseases,(2)reviews published in distant years,and(3)literature of poor quality with unclear language structure.A total of 45 relevant articles meeting the criteria were analyzed.The results indicate numerous common risk factors for heart failure and cancer,including hypertension,diabetes,obesity,gender differences,and unhealthy lifestyle habits such as smoking.Regarding the increased co-occurrence of heart failure and cancer,one viewpoint suggests a shared pathogenesis,including hypotheses such as the inflammatory response,oxidative stress,metabolic reprogramming,microbiome hypothesis,clonal hematopoiesis hypothesis,extracellular matrix hypothesis,angiogenesis hypothesis,and neurohormonal hypothesis.Another viewpoint proposes that heart failure actively promotes the occurrence and development of cancer.Preclinical studies have showed that certain factors secreted by the heart in heart failure mouse models can facilitate the development of certain cancers.Increasing clinical research data also suggest that heart failure patients have a higher risk of developing cancer,which may be gender-related and less strongly associated with age.Therefore,implementing strategies to reduce cardiovascular disease risk in high-risk or cancer-afflicted populations not only lowers cardiovascular morbidity but also effectively reduces cancer mortality.