Современный взгляд на кардиопротекцию онкологических пациентов, получающих кардиотоксичную химиотерапию

Автор: Пересада А.К., Дундуа Д.П., Кедрова А.Г., Олейникова И.Н., Мастеркова А.В.

Журнал: Клиническая практика @clinpractice

Статья в выпуске: 4 т.14, 2023 года.

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Препараты, используемые в лечении онкологических заболеваний, могут оказывать токсичное действие на различные органы и ткани, в том числе и на сердце. К поражению сердечной мышцы может привести не только монотерапия в высокой дозе, но и комбинация двух или трёх химиопрепаратов. Онкологические больные, получающие высокие дозы кардиотоксичных комбинированных противоопухолевых препаратов, имеют повышенный риск сердечно-сосудистых осложнений. В процессе лечения у них могут возникнуть различные нарушения ритма сердца, артериальные и венозные тромбозы, ишемия миокарда, клапанные поражения, артериальная гипертензия и, в частности, хроническая сердечная недостаточность. Важным аспектом является определение групп лиц с исходно высоким или очень высоким риском кардиотоксичности. Такие пациенты на весь срок проведения противоопухолевой терапии должны находиться под наблюдением кардиолога или мультидисциплинарной команды и проходить дообследования. Без необходимого лабораторного и инструментального контроля невозможно заранее предугадать развитие сердечной недостаточности, которая зачастую усложняет проведение жизненно важной химиотерапии, а в некоторых случаях и вовсе служит причиной её отмены. Оказалось, что своевременная кардиопротекция, направленная на профилактику дисфункции миокарда у онкологических больных, позволяет предотвратить развитие сердечной недостаточности и не прерывать пациентам необходимого лечения, особенно на поздней стадии заболевания. В случае верифицированной хронической сердечной недостаточности, которая возникла до начала химиотерапии или в процессе проведения противоопухолевого лечения, применяются препараты с доказанным клиническим эффектом - ингибиторы ангиотензинпревращающего фермента или блокаторы рецепторов ангиотензина и бета-адреноблокаторы. Постепенно накапливаются данные о значимом влиянии на регресс хронической сердечной недостаточности и других групп лекарственных препаратов, применяемых у онкологических больных. Задача данного обзора - кратко отразить механизмы кардиотоксичности при различных схемах химиотерапии, а также современные и будущие возможности кардиопротекции у онкологических больных, получающих кардиотоксичную химиотерапию.

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Кардиоонкология, кардиотоксичность, кардиопротекция, хроническая сердечная недостаточность, ингибиторы натрий-глюкозного котранспортёра 2-го типа

Короткий адрес: https://sciup.org/143182387

IDR: 143182387 | DOI: 10.17816/clinpract567924

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