心衰与肿瘤发生和发展的关系

Relationship of heart failure with occurrence and development of tumors

以往的研究认为,长期患有肿瘤的患者往往会伴随心衰等并发症。然而,近年来研究显示,与正常人相比,心衰患者确诊肿瘤的概率更大,即使在排除肥胖等共同致病因素后仍具有显著差异。这一现象表明,心衰可能是一种致癌条件。有研究人员认为,机体炎性反应水平和氧化应激等病理环境可同时诱导心衰和肿瘤,导致这2种疾病的发生存在交叉现象;另外,也有人认为心衰导致的神经激素系统激活能够直接影响肿瘤的发生、发展及预后。心衰发生时,神经激素系统中交感神经系统(sympathetic nervous system,SNS)和肾素-血管紧张素-醛固酮系统(renin-angiotensinaldosterone system,RAAS)活性大大增强。SNS和RAAS的激活与肿瘤增殖和血管生成密切相关,这可能是心衰导致肿瘤的一条重要途径。这一猜想同时受到实验数据和临床观察的支持。一方面,体内研究显示,SNS或RAAS激活后肿瘤生长和转移扩散增加;另一方面,临床观察结果表明,使用神经激素抑制剂,特别是RAAS阻滞剂能够改善肿瘤患者的预后。探索心衰与肿瘤发生和发展的关系,并阐述心衰作用于肿瘤的具体机制是目前国内外研究的热点,阐明这些问题或许能为临床治疗心衰和肿瘤提供新的依据。

Previous studies have shown that the patients with long-term cancer often have complications such as heart failure.However,the recent studies have shown a heightened risk of incident malignancy in the patients with preexisting heart failure as compared with the normal;there are significant differences even after excluding common pathogenic factors such as obesity.This phenomenon suggests that heart failure may be a carcinogenic condition.Some researchers believe that the systemic pathological processes,such as inflammation and oxidative stress,may promote both heart failure and cancer,leading to the occurrence of these two diseases intersecting.Another hypothesis is that the active neurohormonal system caused by heart failure can directly affect the occurrence,development and prognosis of tumors.When the heart failure occurs,the activities of sympathetic nervous system(SNS)and renin-angiotensin-aldosterone system(RAAS)in the neurohormone system are greatly enhanced.The activation of SNS and RAAS is closely related to the tumor proliferation and angiogenesis,which may be an important way for heart failure to cause tumors.This paradigm is supported by both experimental researches and clinical investigations.On the one hand,tumor growth and metastatic spreading increase following the activation of SNS or RAAS in vivo.On the other hand,the results of clinical observation have shown that the use of neurohormonal inhibitors,especially RAAS blockers,is associated with more favorable cancer outcomes.Exploring the relationship between heart failure and tumorigenesis,and then elucidating the key regulatory mechanisms of heart failure acting on tumors is now becoming a hot topic worldwide.This may provide a new basis for the clinical treatments of both heart failure and tumors.