乳腺癌蒽环类化疗相关心脏毒性早期识别及预防的研究进展

doi:10.3761/j.issn.0254-1769.2023.07.007

摘要/Abstract

摘要：

蒽环类药物相关心脏毒性是接受化疗的乳腺癌患者生存期死亡的首要原因，不仅在一定程度上限制了药物的临床应用，也对患者的远期预后、生活质量及生命造成了严重威胁。蒽环类药物相关心脏毒性的早期识别和干预可提高患者的生存获益，逆转负性结局。该文对乳腺癌蒽环类药物化疗患者心脏毒性危险因素、评估工具以及预防措施进行综述，旨在改善患者的生活质量，最大程度提高患者的生存获益，为临床进一步探索有效的预防措施提供依据。

关键词: 乳腺肿瘤, 蒽环类药物, 化疗, 心脏毒性, 综述, 护理

Abstract:

Anthracycline-induced cardiotoxicity（ACT） is the primary cause of survival death in breast cancer patients receiving chemotherapy，which not only limits the clinical application of drugs to a certain extent，but also poses a serious threat to the long-term prognosis，quality of life and life of patients. Early identification and intervention of ACT can improve the survival benefit of patients and reverse negative outcomes. This article reviews the risk factors，assessment tools and preventive measures of cardiotoxicity in patients with breast cancer undergoing anthracycline chemotherapy，aiming to provide references for clinical nursing care，improve the quality of life of patients and maximize the survival benefit of patients. It also provides a basis for further clinical exploration of effective preventive measures.

Key words: Breast Neoplasms, Anthracyclines, Chemotherapy, Cardiotoxicity, Review, Nursing Care

周彦君, 李秋月, 胡宇乐, 杨浩杰, 赵芳, 梁涛. 乳腺癌蒽环类化疗相关心脏毒性早期识别及预防的研究进展[J]. 中华护理杂志, 2023, 58(7): 816-821.

ZHOU Yanjun, LI Qiuyue, HU Yule, YANG Haojie, ZHAO Fang, LIANG Tao. Research progress on early identification and preventive measures of cardiotoxicity induced by anthracycline chemotherapy in breast cancer[J]. Chinese Journal of Nursing, 2023, 58(7): 816-821.

参考文献 40

[1]	中国抗癌协会肿瘤临床化疗专业委员会, 中国抗癌协会多原发和不明原发肿瘤专业委员会. 中国蒽环类药物治疗乳腺癌专家共识[J]. 癌症, 2021, 40(11):475-485.
	Clinical Chemotherapy Committee of Chinese Anticancer Association, Multi Primary and Unknown Primary Tumor Committee of Chinese Anticancer Association. Chinese expert consensus on anthracycline therapy for breast cancer[J]. Cancer, 2021, 40(11):475-485.
[2]	中国临床肿瘤学会指南工作委员会. 蒽环类药物心脏毒性防治指南(2020版)[M]. 北京: 人民卫生出版社:14.
	Guidelines Working Committee of Chinese Society of Clinical Oncology. Guidelines for prevention and treatment of anthracycline cardiotoxicity(2020)[M]. Beijing: People’s Health publishing House:14
[3]	Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association(EHA),the European Society for Therapeutic Radiology and Oncology(ESTRO) and the International Cardio-Oncology Society(ICOS)[J]. Eur Heart J, 2022:ehac244.
[4]	Sangweni NF, van Vuuren D, Mabasa L, et al. Prevention of anthracycline-induced cardiotoxicity:the good and bad of current and alternative therapies[J]. Front Cardiovasc Med, 2022, 9(1):907266.
[5]	吴玉婷, 陈颖, 朱小丽, 等. 表柔比星化疗的乳腺癌患者心脏毒性的发生及影响因素的研究[J]. 中国药物应用与监测, 2020, 17(5):292-294,309.
	Wu YT, Chen Y, Zhu XL, et al. Study on the occurrence and influencing factors of cardiotoxicity in breast cancer patients treated with epirubicin[J]. Chin J Drug Appl Monit, 2020, 17(5):292-294,309.
[6]	Cardinale D, Iacopo F, Cipolla CM. Cardiotoxicity of anthracyclines[J]. Front Cardiovasc Med, 2020, 7(1):26. DOI URL
[7]	Ghignatti PVDC, Nogueira LJ, Lehnen AM, et al. Cardioprotective effects of exercise training on doxorubicin-induced cardiomyopathy:a systematic review with Meta-analysis of preclinical studies[J]. Sci Rep, 2021, 11(1):6330. DOI PMID
[8]	Varghese SS, Eekhoudt CR, Jassal DS. Mechanisms of anthracycline-mediated cardiotoxicity and preventative strategies in women with breast cancer[J]. Mol Cell Biochem, 2021, 476(8):3099-3109. DOI
[9]	郭芝廷, 陈洁, 郭二菱. 心血管疾病发病风险感知与客观估算风险的相关性及护理对策[J]. 中华护理杂志, 2023, 58(2):150-157. DOI
	Guo ZT, Chen J, Guo EL. Cardiovascular disease risk perception and overall risk:correlation and solutions[J]. Chin J Nurs, 2023, 58(2):150-157.
[10]	沈琳, 孟晓萍, 陈晓明. 心脏康复护理专家共识[J]. 中华护理杂志, 2022, 57(16):1937-1941.
	Shen L, Meng XP, Chen XM. Chinese expert consensus on cardiac rehabilitation nursing care[J]. Chin J Nurs, 2022, 57(16):1937-1941.
[11]	Zhang M, Yang H, Xu C, et al. Risk factors for anthracycline-induced cardiotoxicity in breast cancer treatment:a Meta-analysis[J]. Front Oncol, 2022, 12(1):899782.
[12]	Pudil R, Mueller C, Čelutkienė J, et al. Role of serum biomarkers in cancer patients receiving cardiotoxic cancer therapies:a position statement from the Cardio-Oncology Study Group of the Heart Failure Association and the Cardio-Oncology Council of the European Society of Cardiology[J]. Eur J Heart Fail, 2020, 22(11):1966-1983. DOI URL
[13]	Monteiro AR, Garcia AR, Póvoa S, et al. Acute toxicity and tolerability of anthracycline-based chemotherapy regimens in older versus younger patients with breast cancer:real-world data[J]. Support Care Cancer, 2021, 29(5):2347-2353. DOI
[14]	Reinbolt RE, Patel R, Pan X, et al. Risk factors for anthracycline-associated cardiotoxicity[J]. Support Care Cancer, 2016, 24(5):2173-2180. DOI PMID
[15]	Kaboré EG, Guenancia C, Vaz-Luis I, et al. Association of body mass index and cardiotoxicity related to anthracyclines and trastuzumab in early breast cancer:French CANTO cohort study[J]. PLoS Med, 2019, 16(12):e1002989.
[16]	Swain SM, Whaley FS, Ewer MS. Congestive heart failure in patients treated with doxorubicin:a retrospective analysis of three trials[J]. Cancer, 2003, 97(11):2869-2879. DOI URL
[17]	冯佳, 罗英豪, 王思雄. 阿霉素脂质体与传统制剂治疗晚期乳腺癌效果及毒性的meta分析[J]. 中国老年学杂志, 2017, 37(20):5074-5077.
	Feng J, Luo YH, Wang SX. Meta analysis of efficacy and toxicity of adriamycin liposome and traditional preparation in the treatment of advanced breast cancer[J]. Chin J Gerontology, 2017, 37(20):5074-5077.
[18]	杨润祥, 任宏轩, 庄莉, 等. 表阿霉素微量泵入与静脉滴注不良反应观察[J]. 肿瘤防治研究, 2009, 36(10):872-875.
	Yang RX, Reng HX, Zhuang L, et al. Toxic side-effects of micro-pump and intravenous drip of epirubicin[J]. Canc Res Prev Treat, 2009, 36(10):872-875.
[19]	Van Dalen EC, Van der Pal HJ, Kremer LC. Different dosage schedules for reducing cardiotoxicity in people with cancer receiving anthracycline chemotherapy[J]. Cochrane Database Syst Rev, 2016, 3(3):CD005008.
[20]	Cai F, Luis MAF, Lin X, et al. Anthracycline-induced cardiotoxicity in the chemotherapy treatment of breast cancer:preventive strategies and treatment[J]. Mol Clin Oncol, 2019, 11(1):15-23.
[21]	吕琛, 杜雪亭, 高玲娜, 等. 吡柔比星引起乳腺癌患者心脏毒性反应的相关危险因素分析[J]. 中国新药与临床杂志, 2021, 40 (8):588-591.
	Lü C, Du XT, Gao LN, et al. Analysis of related risk factors for cardiotoxicity in breast cancer patients induced by pirarubicin[J]. Chin J New Drugs Clin Rem, 2021, 40(8):588-591.
[22]	朱小丽, 吕琛, 杜雪亭, 等. 蒽环类药物序贯曲妥珠单抗治疗导致乳腺癌患者心脏毒性的相关危险因素研究[J]. 中国医院用药评价与分析, 2022, 22(3):338-341.
	Zhu XL, Lü C, Du XT, et al. Risk factors of cardiotoxicity in patients with breast cancer after sequential trastuzumab therapy with anthracyclines[J]. Eval Analy Drug-Use Hosp Chin, 2022, 22(3):338-341.
[23]	Darby SC, Ewertz M, McGale P, et al. Risk of ischemic heart disease in women after radiotherapy for breast cancer[J]. N Engl J Med, 2013, 368(11):987-998. DOI URL
[24]	梁莉, 张淑兰, 张照辉, 等. 联合放、化疗与单一化疗对乳腺癌患者心电图的影响[J]. 中华放射医学与防护杂志, 2005, 1(3):262-264.
	Liang L, Zhang SL, Zhang ZH, et al. Comparative analysis of the effect of radiotherapy and chemotherapy or chemotherapy alone on patients’ electrocardiogram[J]. Chin J Radio Med Prot, 2005, 1(3):262-264.
[25]	Anastasiou M, Oikonomou E, Vogiatzi G, et al. Differential effect of anthracycline and trastuzumab cancer therapeutic related vascular toxicity in patients with breast cancer[J]. Eur Heart J, 2020, 41(2):ehaa946.3287.
[26]	Tarantini L, Cioffi G, Gori S, et al. Trastuzumab adjuvant chemo-therapy and cardiotoxicity in real-world women with breast cancer[J]. J Card Fail, 2012, 18(2):113-119. DOI PMID
[27]	Greenlee H, Iribarren C, Rana JS, et al. Risk of cardiovascular disease in women with and without breast cancer:the pathways heart study[J]. J Clin Oncol, 2022, 40(15):1647-1658. DOI URL
[28]	Freites-Martinez A, Santana N, Arias-Santiago S, et al. Using the common terminology criteria for adverse events(CTCAE-Version 5.0) to evaluate the severity of side effects of antineoplastic treatments[J]. Actas Dermo-Sifiliográficas, 2021, 112(1):90-92. DOI URL
[29]	Chang WT, Liu CF, Feng YH, et al. An artificial intelligence approach for predicting cardiotoxicity in breast cancer patients receiving anthracycline[J]. Arch Toxicol, 2022, 96(10):2731-2737. DOI
[30]	Kim DY, Park MS, Youn JC, et al. Development and validation of a risk score model for predicting the cardiovascular outcomes after breast cancer therapy:the CHEMO-RADIAT Score[J]. J Am Heart Assoc, 2021, 10(16)::e021931.
[31]	Gilchrist SC, Barac A, Ades PA, et al. Cardio-oncology rehabilitation to manage cardiovascular outcomes in cancer patients and survivors:a scientific statement from the American Heart Association[J]. Circulation, 2019, 139(21):e997-e1012. DOI
[32]	Heidenreich PA, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure:a report of the American College of Cardiology/American Heart Association Joint Committee on clinical practice guidelines[J]. Circulation,2022, 145(18):e895-e1032. DOI PMID
[33]	Parry TL, Hayward R. Exercise training does not affect anthracycline antitumor efficacy while attenuating cardiac dysfunction[J]. Am J Physiol Regul Integr Comp Physiol, 2015, 309(6):R675-R683. DOI URL
[34]	Schroeder EC, Franke WD, Sharp RL, et al. Comparative effectiveness of aerobic,resistance,and combined training on cardiovascular disease risk factors:a randomized controlled trial[J]. PLoS One, 2019, 14(1):e0210292.
[35]	苏媛媛, 张伟宏, 宋晓月. 抗阻运动对心血管疾病患者心脏康复作用的研究进展[J]. 中华护理杂志, 2017, 52(2):154-157.
	Su YY, Zhang WH, Song XY. Research progress of the effect of resistance exercise on cardiac rehabilitation in patients with cardiovascular diseases[J]. Chin J Nurs, 2017, 52(2):154-157.
[36]	顾怡沁, 李朝凤, 沙莉, 等. 运动疗法防治肿瘤化疗患者心脏毒性效果的Meta分析[J]. 中华护理杂志, 2021, 56(5):775-781. DOI
	Gu YQ, Li CF, Sha L, et al. Effects of exercise therapy on cardiotoxicity in patients with tumor chemotherapy:a Meta-analysis[J]. Chin J Nurs, 2021, 56(5):775-781.
[37]	Kirkham AA, Paterson DI, Prado CM, et al. Rationale and design of the caloric restriction and exercise protection from anthracycline toxic effects(CREATE) study:a 3-arm parallel group phase Ⅱ randomized controlled trial in early breast cancer[J]. BMC Cancer, 2018, 18(1):864. DOI PMID
[38]	Hall SE, Smuder AJ, Hayward R. Effects of calorie restriction and voluntary exercise on doxorubicin-induced cardiotoxicity[J]. Integr Cancer Ther, 2019, 18(1):1534735419843999.
[39]	张欢, 崔丽娜, 李惠艳. 个案管理对肿瘤心脏病患者焦虑抑郁及希望水平的影响[J]. 临床心身疾病杂志, 2021, 27(2):65-67,115.
	Zhang H, Cui LN, Li HY. The effect of case management on anxiety,depression and hope level of cancer patients with heart disease[J]. J Clin Psychosom Dis, 2021, 27(2):65-67,115.
[40]	Lyon AR, López-Fernández T, Couch LS, et al. 2022 ESC guidelines on cardio-oncology developed in collaboration with the European Hematology Association(EHA),the European Society for Therapeutic Radiology and Oncology(ESTRO) and the International Cardio-Oncology Society(ICOS):developed by the task force on cardio-oncology of the European Society of Cardiology(ESC)[J]. Eur Heart J, 2022, 43(41):4229-4361. DOI URL