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目前临床上广泛用于急性白血病化疗的药物,常具有严重的毒副反应包括心肌毒性,其引起的充血性心力衰竭(congestive heart failure,CHF)已成为急性白血病患者化疗后的致死原因之一。因此在维持化疗药物治疗效果的同时,降低其心脏毒性,减少急性白血病化疗后心肌病是近年来的研究热点。关于这方面的研究进展主要包括监测技术的进展、高效低毒化疗药物的研究和应用进展以及心肌保护剂的进展。监测手段的研究进展使得对心肌损伤的监测更敏感、更便于操作。抗肿瘤药物衍生物的研究进展如去甲氧柔红霉素(idarubicin,IDA)、米托蒽醌(mitoxantrone,MTZ)及脂质体阿霉素(liposomal anthracyclines)等高效低毒药物在增强了其抗肿瘤活性的同时,明显降低了其心肌毒性,减少了心肌病的发生率。另外制定化疗方案前应充分评估患者高危因素,限制累积剂量的应用也明显降低了化疗药物的心肌毒性。心肌保护剂的应用也已成为防治急性白血病化疗后心肌病的有效手段,如右丙亚胺(Dexrazoxane,DEX)有明确的心肌保护作用,研究表明DEX的使用并不影响抗肿瘤药物原有的抗肿瘤活性,有广泛的临床应用价值。
Currently widely used in clinical chemotherapy of acute leukemia drugs, often have serious side effects, including myocardial toxicity, which caused by congestive heart failure (CHF) has become one of the leading causes of death in patients with acute leukemia after chemotherapy. Therefore, while maintaining the therapeutic effect of chemotherapy drugs, reducing its cardiotoxicity and reducing cardiomyopathy after acute leukemia chemotherapy is a hot research topic in recent years. The research progress in this respect mainly includes the progress of monitoring technology, the research and application progress of highly effective and low toxic chemotherapeutic drugs and the progress of myocardial protective agent. Research advances in monitoring methods make the monitoring of myocardial injury more sensitive and easier to operate. Advances in the development of antitumor drug derivatives such as idarubicin (IDA), mitoxantrone (MTZ) and liposomal anthracyclines have been shown to be highly effective Its anti-tumor activity at the same time, significantly reduced its myocardial toxicity and reduce the incidence of cardiomyopathy. In addition to the development of chemotherapy programs should be fully evaluated the risk factors of patients, limiting the cumulative dose of application also significantly reduced the toxicity of chemotherapy drugs. The application of cardioprotective agents has also become an effective means of preventing and treating cardiomyopathy after chemotherapy for acute leukemia. For example, dexrazoxane (DEX) has a definite myocardial protective effect. Studies have shown that the use of DEX does not affect the original anti-tumor drugs Anti-tumor activity, has a wide range of clinical value.