蒽环类抗肿瘤药物的心脏毒性及保护剂的研究进展.pdfVIP

2011 年第38 卷第16期 中国肿瘤临床 991 蒽环类抗肿瘤药物的心脏毒性及保护剂的研究进展 ① ① ② 姜 龙 龙 浩 综述 王华庆 审校 摘要 由于蒽环类药物显著的抗肿瘤作用和广泛的临床应用，其临床应用的安全性越来越受到重视。该类药物的心脏毒 性表现为剂量限制性的特点。目前唯一获批的蒽环类药物心脏毒性保护剂只有右丙亚胺，其心脏保护作用已经得到了广泛认 可，并被美国临床肿瘤实践指南及其他多种国内外指南推荐应用于蒽环类药物心脏毒性的预防和治疗。有关右丙亚胺的临床应 用策略，目前仍存在一定争议。本文探讨了右丙亚胺对蒽环类药物抗肿瘤效价的影响、右丙亚胺用药时机的选择、右丙亚胺临床 应用的安全性以及正在研究中的可能具有心脏保护功能的药物。 关键词 蒽环类 心脏损伤 药物毒性 保护剂 doi:10.3969/j.issn. 1000-8179.2011.16.017 Hot Issues in the Clinical Application of Protective Agents against Cardiac Toxicity Caused by Anthracyclines 1 1 2 Long JIANG , Hao LONG , Huaqing WANG Correspondence to: Hao LONG, E-mail: drlongh@ 1Cancer Center, Sun Yat-sen University, Guangzhou 510060, China 2Tianjin Medical University Cancer Institute and Hospital, Tianjin 300060, China Abstract Anthracyclines have attracted growing attention because of their significant anti-cancer effect, safe clinical applica- tion, and great market demand. However, the cardiac toxicity of anthracycline limits its dosage. Dexrazoxane is the only approved car- dioprotective agent that has been widely accepted. Dexrazoxane has also been recommended by many guidelines in China and overseas, such as the American Society of Clinical Oncology 2008 Clinical Practice Guideline. However, controversy surrounds the details of the clinical use of Dexrazoxane. In this paper, we have discussed the possibility that Dexrazoxane influences anti-tumor efficacy. In addi- tion, we have tackled the administration, safety, and other possible cardioprotective effects of Dexrazoxane. Keywords Anthracyclines; Heart injuries; Drug toxicity; Protective agents 蒽环类药物，包括阿霉素，表阿霉素，吡喃阿霉 难等。监测方法包括心电图、MUGA、超声心动图、心 素，柔红霉素及米托蒽醌等，已广泛应用于实体瘤和 肌酶谱、心内膜心肌活检、血清肌钙蛋白、脑钠肽 血液系统肿瘤的治疗中并取得了突出的疗