【《肺癌心脏病的研究现状的文献综述》2600字】

肺癌心脏病的研究现状的文献综述肿瘤心脏病学是近年来国际上新兴发展起来的一个医学领域，也是一个获得肿瘤学和心血管病学专家越来越多关注的交叉学科。2009年肿瘤心脏病学的概念在欧洲诞生ADDINEN.CITEADDINEN.CITE.DATA[\o"Cardinale,2008#612"17-19]。直到目前为止，肿瘤和心血管疾病的交叉学科在很多西方发达国家如美国、加拿大、意大利、英国等发展得比较快，这些国家的许多医疗机构都单独开设针对肿瘤心脏病的诊断和治疗的部门，并配备了专业的肿瘤心脏病临床专家和科研人员。直到2016年6月中国才开始推广肿瘤心脏病学的概念。肺癌心脏病学的研究范围主要包括以下几方面：肺癌合并心血管疾病；抗肺癌的治疗方法所诱发的心血管事件；导致肺癌和心血管疾病的共同因素及其预防ADDINEN.CITEADDINEN.CITE.DATA[\o"Francis,2015#614"20-22]。（1）关于肺癌合并心血管疾病方面：早期的报道指出7%的癌症死亡率可能是由心脏衰竭而导致ADDINEN.CITE<EndNote><Cite><Author>Ambrus</Author><Year>1975</Year><RecNum>356</RecNum><DisplayText><styleface="superscript">[23]</style></DisplayText><record><rec-number>356</rec-number><foreign-keys><keyapp="EN"db-id="ew2x2zrfipra2de95fcve0apzv9sr0pexv5p"timestamp="1611286217">356</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Ambrus,J.L.</author><author>Ambrus,C.M.</author><author>Mink,I.B.</author><author>Pickren,J.W.</author></authors></contributors><titles><title>Causesofdeathincancerpatients</title><secondary-title>JMed</secondary-title></titles><periodical><full-title>JMed</full-title></periodical><pages>61-4</pages><volume>6</volume><number>1</number><keywords><keyword>Autopsy</keyword><keyword>Bronchopneumonia/etiology</keyword><keyword>Cachexia/etiology</keyword><keyword>HeartArrest/etiology</keyword><keyword>Hemorrhage/etiology</keyword><keyword>HepaticEncephalopathy/etiology</keyword><keyword>Humans</keyword><keyword>KidneyFailure,Chronic/etiology</keyword><keyword>NeoplasmMetastasis/etiology</keyword><keyword>Neoplasms/complications/*mortality</keyword><keyword>Peritonitis/etiology</keyword><keyword>PulmonaryEmbolism/etiology</keyword><keyword>RespiratoryInsufficiency/etiology</keyword><keyword>Sepsis/etiology</keyword><keyword>Thromboembolism/etiology</keyword></keywords><dates><year>1975</year></dates><isbn>0025-7850(Print) 0025-7850(Linking)</isbn><accession-num>1056415</accession-num><urls><related-urls><url>/pubmed/1056415</url></related-urls></urls></record></Cite></EndNote>[\o"Ambrus,1975#356"23]。1）肺癌可以转移至心血管系统，比如心包、心肌组织、心内膜、冠状动脉等，肺癌转移到心脏可以导致相应的临床表现。在这些心脏转移类型中，肺癌对心包的侵害是最主要的，第二是心肌组织，最少见的是转移至心内膜等部位。一项研究显示在经统计的402例肺癌患者里有15.7%发生了心包转移，10.2%发生了心肌转移，5.4%发生了心肌并发心包转移ADDINEN.CITE<EndNote><Cite><Author>Applefeld</Author><Year>1980</Year><RecNum>684</RecNum><DisplayText><styleface="superscript">[24]</style></DisplayText><record><rec-number>684</rec-number><foreign-keys><keyapp="EN"db-id="ew2x2zrfipra2de95fcve0apzv9sr0pexv5p"timestamp="1621673655">684</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Applefeld,M.M.</author><author>Pollock,S.H.</author></authors></contributors><titles><title>Cardiacdiseaseinpatientswhohavemalignancies</title><secondary-title>CurrProblCardiol</secondary-title></titles><periodical><full-title>CurrProblCardiol</full-title></periodical><pages>1-37</pages><volume>4</volume><number>11</number><keywords><keyword>CoronaryDisease/etiology</keyword><keyword>Dose-ResponseRelationship,Radiation</keyword><keyword>Doxorubicin/*adverseeffects</keyword><keyword>Heart/radiationeffects</keyword><keyword>HeartDiseases/*etiology</keyword><keyword>HeartFailure/chemicallyinduced</keyword><keyword>HeartNeoplasms/*secondary</keyword><keyword>Humans</keyword><keyword>Myocardium/pathology</keyword><keyword>Neoplasms/complications/therapy</keyword><keyword>Pericarditis/etiology</keyword><keyword>Radiotherapy,High-Energy/*adverseeffects</keyword></keywords><dates><year>1980</year><pub-dates><date>Feb</date></pub-dates></dates><isbn>0146-2806(Print) 0146-2806(Linking)</isbn><accession-num>6788442</accession-num><urls><related-urls><url>/pubmed/6788442</url></related-urls></urls><electronic-resource-num>10.1016/0146-2806(80)90005-5</electronic-resource-num></record></Cite></EndNote>[\o"Applefeld,1980#684"24]。如果心包受损则会引发心包积液，心脏堵塞以及收缩性心包炎。当心包积液积累到比较大的体积时，心脏前后的游离运动就会导致心电图的电交替现象。肺部癌细胞如果转移到左、右心房，则会影响二尖瓣或者三尖瓣功能，此类情况容易与房粘液瘤相混淆。肺癌如果转移到右、左室，则可以引起右、左室的流出道发生阻塞、猝死等严重后果ADDINEN.CITE<EndNote><Cite><Author>Itoh</Author><Year>1984</Year><RecNum>685</RecNum><DisplayText><styleface="superscript">[25]</style></DisplayText><record><rec-number>685</rec-number><foreign-keys><keyapp="EN"db-id="ew2x2zrfipra2de95fcve0apzv9sr0pexv5p"timestamp="1621673852">685</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Itoh,K.</author><author>Matsubara,T.</author><author>Yanagisawa,K.</author><author>Hibi,N.</author><author>Nishimura,K.</author><author>Kambe,T.</author><author>Sakamoto,N.</author><author>Tanaka,M.</author><author>Abe,T.</author></authors></contributors><titles><title>Rightventricularmetastasisofcervicalsquamouscellcarcinoma</title><secondary-title>AmHeartJ</secondary-title></titles><periodical><full-title>AmHeartJ</full-title></periodical><pages>1369-71</pages><volume>108</volume><number>5</number><keywords><keyword>Carcinoma,SquamousCell/*secondary</keyword><keyword>Female</keyword><keyword>HeartNeoplasms/*secondary</keyword><keyword>HeartVentricles/pathology</keyword><keyword>Humans</keyword><keyword>MiddleAged</keyword><keyword>NeoplasticCells,Circulating</keyword><keyword>PulmonaryEmbolism/etiology</keyword><keyword>*UterineCervicalNeoplasms</keyword></keywords><dates><year>1984</year><pub-dates><date>Nov</date></pub-dates></dates><isbn>0002-8703(Print) 0002-8703(Linking)</isbn><accession-num>6496298</accession-num><urls><related-urls><url>/pubmed/6496298</url></related-urls></urls><electronic-resource-num>10.1016/0002-8703(84)90771-3</electronic-resource-num></record></Cite></EndNote>[\o"Itoh,1984#685"25]。晚期恶性肿瘤引起的严重心脏并发症是恶性心包积液，虽然恶性心包积液可由心脏或者心包的原发性肿瘤导致，但是这种现象常常见于转移性的恶性肺癌ADDINEN.CITEADDINEN.CITE.DATA[\o"ElHaddad,2015#679"26,\o"Imazio,2020#680"27]，由肺癌转移引起的肿瘤相关的心包积液可达40%ADDINEN.CITEADDINEN.CITE.DATA[\o"Maisch,2004#681"28]。一项研究发现ADDINEN.CITEADDINEN.CITE.DATA[\o"Kato,2017#682"29]，合并恶性心包积液的非小细胞肺癌患者生存率远远低于合并恶性心包积液的非小细胞肺癌患者，在合并少量的心包积液的非小细胞肺癌患者中，有14.8%的患者可发展恶性心包积液，这类患者的生存期只有短短的6.2个月；伴有大量体积恶性心包积液的患者存活时间均十分短暂ADDINEN.CITE<EndNote><Cite><Author>Wang</Author><Year>2000</Year><RecNum>683</RecNum><DisplayText><styleface="superscript">[30]</style></DisplayText><record><rec-number>683</rec-number><foreign-keys><keyapp="EN"db-id="ew2x2zrfipra2de95fcve0apzv9sr0pexv5p"timestamp="1621672554">683</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Wang,P.C.</author><author>Yang,K.Y.</author><author>Chao,J.Y.</author><author>Liu,J.M.</author><author>Perng,R.P.</author><author>Yen,S.H.</author></authors></contributors><auth-address>ChestDepartment,TaipeiVeteransGeneralHospital,Taiwan.</auth-address><titles><title>Prognosticroleofpericardialfluidcytologyincardiactamponadeassociatedwithnon-smallcelllungcancer</title><secondary-title>Chest</secondary-title></titles><periodical><full-title>Chest</full-title></periodical><pages>744-9</pages><volume>118</volume><number>3</number><keywords><keyword>Aged</keyword><keyword>BodyFluids/*cytology</keyword><keyword>Carcinoma,Non-Small-CellLung/*complications/mortality/pathology/therapy</keyword><keyword>CardiacTamponade/etiology/mortality/*pathology/surgery</keyword><keyword>CombinedModalityTherapy</keyword><keyword>Diagnosis,Differential</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>LungNeoplasms/*complications/mortality/pathology/therapy</keyword><keyword>Male</keyword><keyword>PericardialEffusion/complications/mortality/*pathology/surgery</keyword><keyword>Pericardiocentesis</keyword><keyword>Prognosis</keyword><keyword>SurvivalRate</keyword></keywords><dates><year>2000</year><pub-dates><date>Sep</date></pub-dates></dates><isbn>0012-3692(Print) 0012-3692(Linking)</isbn><accession-num>10988197</accession-num><urls><related-urls><url>/pubmed/10988197</url></related-urls></urls><electronic-resource-num>10.1378/chest.118.3.744</electronic-resource-num></record></Cite></EndNote>[\o"Wang,2000#683"30]。针对该类疾病的防治也有部分研究成果，比如用第一代铂类抗肿瘤药物进行滴注治疗，有研究显示将第一代铂类抗肿瘤药物的代表药顺铂滴入心包腔以后可以显著地对肺癌患者恶性心包积液的复发起到预防的作用ADDINEN.CITE<EndNote><Cite><Author>Maisch</Author><Year>2002</Year><RecNum>686</RecNum><DisplayText><styleface="superscript">[31]</style></DisplayText><record><rec-number>686</rec-number><foreign-keys><keyapp="EN"db-id="ew2x2zrfipra2de95fcve0apzv9sr0pexv5p"timestamp="1621674802">686</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Maisch,B.</author><author>Ristic,A.D.</author><author>Pankuweit,S.</author><author>Neubauer,A.</author><author>Moll,R.</author></authors></contributors><auth-address>DepartmentofInternalMedicine-Cardiology,PhilippsUniversity,Marburg,Germany.</auth-address><titles><title>Neoplasticpericardialeffusion.Efficacyandsafetyofintrapericardialtreatmentwithcisplatin</title><secondary-title>EurHeartJ</secondary-title></titles><periodical><full-title>EurHeartJ</full-title></periodical><pages>1625-31</pages><volume>23</volume><number>20</number><keywords><keyword>Aged</keyword><keyword>AntineoplasticAgents/adverseeffects/*therapeuticuse</keyword><keyword>Cisplatin/adverseeffects/*therapeuticuse</keyword><keyword>Female</keyword><keyword>Humans</keyword><keyword>Male</keyword><keyword>MiddleAged</keyword><keyword>MyocardialIschemia/chemicallyinduced</keyword><keyword>Neoplasms/*complications</keyword><keyword>PericardialEffusion/*drugtherapy/*etiology/prevention&control</keyword><keyword>SecondaryPrevention</keyword></keywords><dates><year>2002</year><pub-dates><date>Oct</date></pub-dates></dates><isbn>0195-668X(Print) 0195-668X(Linking)</isbn><accession-num>12323163</accession-num><urls><related-urls><url>/pubmed/12323163</url></related-urls></urls><electronic-resource-num>10.1053/euhj.2002.3328</electronic-resource-num></record></Cite></EndNote>[\o"Maisch,2002#686"31]。除了需要重视治疗药物的选择以外，开始进行治疗的时机选择也十分重要。当肺癌患者出现心包积液的时候应尽量采用心包穿刺及心包腔内化疗，这种方法在没有出现心包堵塞的情况效果比较明显ADDINEN.CITEADDINEN.CITE.DATA[\o"Lestuzzi,2011#687"32]。2）肺癌可以导致肺动脉高压和右心功能受损。一项研究发现在肺癌患者中，一半以上的肺癌患者同时患有肺动脉高压；在小鼠肺癌模型中，随著肺癌的发展，肺癌小鼠开始表现出肺动脉高压的症状。该研究提出肺癌可以诱发肺动脉高压和右心功能受损，针对这一现象的解释是：虽然在病人和老鼠模型中均未观察到有凝块以及肺癌细胞迁移到血管壁的现象。但是发现有大量的免疫细胞浸润到了肺癌周围的血管。免疫细胞可以在肺癌引起的炎症反应中释放各种化学信号，肺动脉高压不会发生在肺癌小鼠缺乏有效免疫细胞的时候，故肺癌所致炎症反应可能为肺动脉高压的病因。这种机制也成为新的治疗靶点。3）有研究表明癌症可以引发恶病质，癌症恶病质也可以导致心功能损害。癌症患者或癌症动物模型在癌症发病严重时心脏会出现萎缩现象，线粒体稳态随之受到破坏，氧化能力也明显降低，这些功能障碍严重阻碍了心脏能量的代谢，因此肺癌释放的炎症因子被认为是诱发心力衰竭的重要原因ADDINEN.CITE<EndNote><Cite><Author>Belloum</Author><Year>2017</Year><RecNum>688</RecNum><DisplayText><styleface="superscript">[33]</style></DisplayText><record><rec-number>688</rec-number><foreign-keys><keyapp="EN"db-id="ew2x2zrfipra2de95fcve0apzv9sr0pexv5p"timestamp="1621685821">688</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Belloum,Y.</author><author>Rannou-Bekono,F.</author><author>Favier,F.B.</author></authors></contributors><titles><title>Cancer-inducedcardiaccachexia:Pathogenesisandimpactofphysicalactivity</title><secondary-title>OncologyReports</secondary-title></titles><periodical><full-title>OncologyReports</full-title></periodical><dates><year>2017</year></dates><urls></urls></record></Cite></EndNote>[\o"Belloum,2017#688"33]。关于肿瘤恶病质的机制研究方面，肿瘤引起的心肌纤维化和肌纤维缺失与Myostatin和TWEAK的增加是有关联的，信号通路Smad-3、NF-κB、TRAF-6和atrogin1的激活与此有关ADDINEN.CITEADDINEN.CITE.DATA[\o"Padrao,2015#669"34]。孕激素和非甾体抗炎药是目前被研究最多的癌症恶病质药物，但是它们似乎不能保护心脏。目前研究得最深入的的癌症恶病质药物是孕激素和非甾体抗炎药，但是它们似乎不能保护心脏。对于心衰的治疗，可以通过直接调整神经体液途径来显著降低其进展而实现，一旦出现左室功能不全，血管紧张素转换酶抑制剂和β受体阻滞剂效果十分显著。但是，这两类药物在癌症患者中治疗心力衰竭的价值仍被忽视ADDINEN.CITE<EndNote><Cite><Author>Colombo</Author><Year>2013</Year><RecNum>673</RecNum><DisplayText><styleface="superscript">[35]</style></DisplayText><record><rec-number>673</rec-number><foreign-keys><keyapp="EN"db-id="ew2x2zrfipra2de95fcve0apzv9sr0pexv5p"timestamp="1621660927">673</key></foreign-keys><ref-typename="JournalArticle">17</ref-type><contributors><authors><author>Colombo,A.</author><author>Cardinale,D.</author></authors></contributors><auth-address>CardiologyDivision,EuropeanInstituteofOncology,ViaRipamonti435,20141Milan,Italy.alessandro.colombo@ieo.it</auth-address><titles><title>Usingcardiacbiomarkersandtreatingcardiotoxicityincancer</title><secondary-title>FutureCardiol</secondary-title></titles><periodical><full-title>FutureCardiol</full-title></periodical><pages>105-18</pages><volume>9</volume><number>1</number><keywords><keyword>Angiotensin-ConvertingEnzymeInhibitors/therapeuticuse</keyword><keyword>AntineoplasticAgents/*adverseeffects</keyword><keyword>Biomarkers/metabolism</keyword><keyword>HeartFailure/*diagnosis/etiology/*therapy</keyword><keyword>Humans</keyword><keyword>NatriureticPeptides/metabolism</keyword><keyword>Neoplasms/complications/*drugtherapy/pathology</keyword><keyword>Troponin/metabolism</keyword><keyword>VentricularDysfunction,Left/*diagnosis/etiology/*therapy</keyword></keywords><dates><year>2013</year><pub-dates><date>Jan</date></pub-dates></dates><isbn>1744-8298(Electronic) 1479-6678(Linking)</isbn><accession-num>23259478</accession-num><urls><related-urls><url>/pubmed/23259478</url></related-urls></urls><electronic-resource-num>10.2217/fca.12.73</electronic-resource-num></record></Cite></EndNote>[\o"Colombo,2013#673"35]。如果不用药物进行治疗，锻炼看起来像是一种有潜在预防作用的方法，它能防止或抵消心脏损伤，而有氧训练则能调节癌症患者的继发性心脏重构ADDINEN.CITEADDINEN.CITE.DATA[\o"Alves,2015#674"36]。（2）关于抗肺癌治疗所致心血管毒性方面：欧洲心脏病学会肿瘤治疗与心血管毒性合作组于2016年8月28日撰写了《2016年欧洲心脏病学会肿瘤治疗与心血管毒性合作组声明》，该文综述了抗肿瘤药物心血管毒性病理生理学的特点，提出了防治措施，并对慢性期病人的诊断与治疗提出了规范建议，对肿瘤心血管疾病的预防、诊断与治疗具有重要意义ADDINEN.CITEADDINEN.CITE.DATA[\o"Zamorano,2017#611"18]。（3）导致肺癌和心血管疾病的共同因素及其预防：吸烟、不良生活习惯、等诸多因素与心血管病、恶性肺癌密切相关，可联合预防。直到目前为止，肺癌心脏病的病理生理学机制仍不清楚，防治手段也十分局限。参考文献[1] SIEGELRL,MILLERKD,FUCHSHE,etal.CancerStatistics,2021[J].CACancerJClin,2021,71(1):7-33.[2] BRAYF,FERLAYJ,SOERJOMATARAMI,etal.Globalcancerstatistics2018:GLOBOCANestimatesofincidenceandmortalityworldwidefor36cancersin185countries[J].CACancerJClin,2018,68(6):394-424.[3] 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