中药治疗抗癌药物引发心脏毒性的研究进展

Research progress on traditional Chinese medicine in treating cardiotoxicity induced by anticancer drugs

摘要

抗癌药物所致心脏毒性是影响肿瘤患者预后的重要因素。本文系统归纳了化疗药、分子靶向治疗药和免疫治疗药引发心脏毒性的临床表征，并指出其核心毒性机制涉及心肌细胞凋亡、氧化应激失衡及线粒体功能障碍等。在中医理论中，抗癌药导致的心脏毒性属“热毒”范畴，其核心病机是气血不足、心火亢盛、心血瘀阻、痰湿阻滞。因此，本文通过梳理补虚药、清热药、活血祛瘀药、化痰止咳平喘药和温里药的防治作用及机制，发现其组方原则为“扶正解毒祛瘀”，这些中药主要通过抗氧化应激、调节自噬平衡、抑制炎症反应、改善微循环等机制发挥防治作用。上述作用机制与现代医学治疗策略（如右雷佐生抑制铁依赖性氧化应激、他汀类药物抗炎等）高度契合。本文旨在为中西医协同精准防治抗癌药物心脏毒性提供理论支撑与实践参考。

Abstract

Cardiotoxicity induced by antineoplastic agents is an important factor affecting the prognosis of cancer patients. This article systematically summarizes the clinical manifestations of cardiotoxicity caused by chemotherapeutic drugs, molecular targeted cancer therapies, and immunotherapeutic drugs, and identifies the core injury mechanisms, including cardiomyocyte apoptosis, oxidative stress, and mitochondrial dysfunction. In Traditional Chinese Medicine (TCM) theory, anticancer drug-induced cardiotoxicity falls under the category of “heat toxins” characterized by dual deficiency of qi and blood, upward flaming of heart heat, stagnation of the heart vessels, and meridian obstruction induced by phlegm-dampness. Therefore, by reviewing the preventive and therapeutic effects and the underlying mechanisms of tonic medicines, interior heat-clearing medicines, blood-circulating and stasis-resolving medicines, phlegm-transforming, cough-suppressing and panting-relieving medicines, and interior-warming medicines, this paper concludes that TCM prevention and treatment of this condition adheres to the formulation principle of “reinforcing healthy qi, removing toxins, and resolving blood stasis”. Its mechanisms of action—including antioxidation effects, regulation of autophagic balance, antagonism of inflammatory responses, and improvement of microcirculation—are highly consistent with modern medical treatment strategies (e.g., dexrazoxane for inhibiting iron-dependent oxidative stress, statins for anti-inflammatory effects). This study provides theoretical support and practical guidance for the collaborative and precise prevention and treatment of anticancer drug-induced cardiotoxicity through the integration of traditional Chinese and Western medicine.

关键词

癌症 / 肿瘤心脏病 / 心脏毒性 / 中药 / 抗癌药

Key words

cancer / cardio-oncology disease / cardiotoxicity / traditional Chinese medicine / anticancer drugs

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基金资助

国家自然科学基金项目(82260792)

甘肃省青年人才项目(2025QNGR2)

甘肃中医药大学研究生“创新创业基金”项目(2025CXCY-037)