放射性心脏损伤的研究进展

Research progress in radiation-induced heart disease

传统观点认为心脏不良反应是放射治疗的晚期不良反应。从经典放射生物学的角度来看,心脏这类非增殖且高度分化的组织,应当对电离辐射有着较强的抵抗力。但随着对放射性心脏损伤(RIHD)认识的深入,研究者们发现辐射可以引起心脏的多种病理生理变化,包括内皮功能障碍、炎症、血栓形成和心脏纤维化等,并且随着放射剂量的增加,这些损伤过程可能会显著加速。当前多学科联合治疗模式下,肿瘤患者的疗效取得了显著改善,生存期的延长导致更多的患者面临治疗相关心脏不良反应的风险,RIHD也因此逐渐成为目前的研究热点之一。本文系统介绍近年来RIHD发生情况、放疗技术与RIHD、检测与诊断方法、发生机制及治疗措施等情况。

Cardiotoxicity is traditionally regarded as the late toxic side effect of radiotherapy.Classical radiobiology suggests that non-proliferative and highly-differentiated tissues,such as the heart,should exhibit robust resistance to ionizing radiation.However,in-depth analyses of radiation-induced heart disease(RIHD)have discovered that radiation can induce a range of physiological changes in the heart.These changes,which include endothelial dysfunction,inflammation,thrombosis,and cardiac fibrosis,may be significantly accelerated as radiation doses increase.At present,multidisciplinary team treatment modalities have substantially enhanced curative effects for cancer patients.However,the resulting prolongation of survival time exposes a larger patient population to the risks of treatment-related cardiotoxicity,establishing RIHD as a pressing research concern.This article offers a systematic review of recent insights into the incidence of RIHD,the relationship between radiotherapy and RIHD,methods for its detection and diagnosis,as well as its pathogenesis and potential treatment strategies.