摘要
癌症相关心房颤动(cancer-related atrial fibrillation,CR-AF)是癌症患者常见的并发症,其发生多与肿瘤本身、相关治疗手段及全身性炎症反应密切相关。随着癌症治疗水平的提升和患者生存期的延长,CR-AF的发病率显著上升,已成为肿瘤心脏病学领域的重要研究方向。在肺癌、乳腺癌和食管癌患者中,房颤的发生率较高;CR-AF可显著增加脑卒中、心力衰竭及全身性栓塞的风险,从而影响患者生活质量和远期预后。CR-AF发病机制涉及肿瘤相关系统性炎症、氧化应激、心房结构重构等多种因素,化学药物治疗与放射治疗的心脏毒性也可能促进房颤发生。尽管CR-AF的临床意义日益受到重视,但目前常用的房颤风险评估工具(如CHA_(2)DS_(2)-VASc和HAS-BLED)在癌症人群中的应用存在一定局限性,且抗凝治疗面临血栓与出血风险并存的挑战。未来研究应致力于精准风险评估、个体化治疗策略及早期干预措施,以改善癌症患者的整体治疗效果与生活质量。
Cancer-related atrial fibrillation(CR-AF)is a common complication in cancer patients,closely associated with the tumor itself,anti-cancer treatments,and systemic inflammatory responses.With advances in cancer treatment and prolonged survival of patients,the incidence of CR-AF has increased significantly,making it an important research focus in the field of cardio-oncology.Atrial fibrillation is particularly prevalent among patients with lung,breast,or esophageal cancers.CR-AF significantly elevates the risk of stroke,heart failure,and systemic embolism,thereby adversely affecting patients'quality of life and long-term prognosis.The pathogenesis of CR-AF involves multiple mechanisms,including tumor-induced systemic inflammation,oxidative stress,and atrial structural remodeling,while the cardiotoxic effects of chemotherapy and radiotherapy may also promote the occurrence of atrial fibrillation.Although the clinical significance of CR-AF is gaining increasing attention,currently used assessment tools for atrial fibrillation risk such as CHA_(2)DS_(2)-VASc and HAS-BLED have limitations in cancer populations.Moreover,anticoagulation therapy faces the challenge of balancing thrombotic and bleeding risks.Future research should focus on precise risk assessment,individualized treatment strategies,and early intervention to improve overall treatment outcomes and quality of life in cancer patients.
作者
韩丹丹
刘继军
朱红
裴媛媛
刘银超
陈喜园
魏阳
王超
HAN Dandan;LIU Jijun;ZHU Hong;PEI Yuanyuan;LIU Yinchao;CHEN Xiyuan;WEI Yang;WANG Chao(Department of Cardiology,Kaifeng 155 Hospital,Kaifeng Henan 475003;Department of Medical Oncology,Affiliate Cancer Hospital of University of Electronic Science and Technology of China,Chengdu Sichuan 610041;International Geriatric Medical Center,the Third People's Hospital of Chengdu,Chengdu Sichuan 610031,China)
出处
《实用心电与临床诊疗》
2025年第6期904-909,916,共7页
PRACTICAL ELECTROCARDIOLOGY AND CLINICAL TREATMENT
基金
开封市科学技术局资助项目(2503032)。
关键词
心房颤动
癌症
心脏毒性
化学药物治疗
放射治疗
抗凝策略
atrial fibrillation
cancer
cardiotoxicity
chemotherapy
radiation therapy
anticoagulation strategy
