[1]李艳阳,史国花,范鹿,等.基于“虚-毒-瘀”探讨肿瘤治疗相关性心血管毒性病机[J].陕西中医,2026,(8):1074-1078.[doi:DOI:10.3969/j.issn.1000-7369.2026.08.011]
　LI Yanyang,SHI Guohua,FAN Lu,et al.Exploring pathogenesis evolution of Deficiency-Toxin-Stasis in cancer therapy-related cardiovascular toxicity[J].,2026,(8):1074-1078.[doi:DOI:10.3969/j.issn.1000-7369.2026.08.011]
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基于“虚-毒-瘀”探讨肿瘤治疗相关性心血管毒性病机

《陕西中医》[ISSN:1000-7369/CN:61-1281/TN]

卷:
期数:
2026年8期
页码:
1074-1078
栏目:
学术探讨
出版日期:
2026-08-05

文章信息/Info

Title:
Exploring pathogenesis evolution of Deficiency-Toxin-Stasis in cancer therapy-related cardiovascular toxicity
作者:
李艳阳1; 史国花2; 范鹿2; 吕仕超2; 朱林平3
（1．天津中医药大学研究生院，天津301617；2.天津中医药大学第一附属医院老年病科 中医国家临床医学研究中心，天津 300381；3.天津中医药大学第二附属医院心血管科，天津300350）
Author(s):
LI Yanyang1; SHI Guohua2; FAN Lu2; LYU Shichao2; ZHU Linping3
（1.Graduate School,Tianjin University of Traditional Chinese Medicine,Tianjin 301617,China；2.Geriatrics Department,First Teaching Hospital of Tianjin University of Traditional Chinese Medicine,National Clinical Research Center for Chinese Medicine,Tianjin 300381,China；3.Cardiovascular Department,The Second Affiliated Hospital of Tianjin University of Traditional Chinese Medicine,Tianjin 300350,China）
关键词:
肿瘤心脏病学; 气阴两虚; 毒损心络; 瘀血阻滞; 免疫; 炎症
Keywords:
Cardio-Oncology; Qi and Yin deficiency; Toxin-induced damage to the heart meridians; Blood stasis obstruction; Immunity; Inflammation
分类号:
R 73
DOI:
DOI:10.3969/j.issn.1000-7369.2026.08.011
文献标志码:
A
摘要:
肿瘤治疗相关性心血管毒性是抗肿瘤治疗过程的重要不良反应，也是导致肿瘤患者死亡的主要原因之一。其发病机制复杂，现代医学缺乏特异性防治手段。本文基于“虚-毒-瘀”理论，系统阐述该病的病机演变规律。“虚、毒、瘀”三者相互交错、相互影响，贯穿疾病全程。其中，气阴两虚为发病之本，肿瘤患者正气本虚，抗肿瘤药物属火热邪毒，“以毒攻毒”之际进一步耗气伤阴，导致心气失充、津液亏乏，引发心悸、胸闷、乏力等症。益气养阴法通过调节免疫、减轻氧化应激、改善线粒体功能，降低蒽环类药物等引起心脏毒性发生率。毒损心络为病机关键。药毒蓄积体内，日久损伤心络，导致心肌间质纤维化、细胞异常凋亡，呈剂量依赖性心脏损伤。毒邪可诱发血管内皮损伤及炎症反应，而解毒通络类中药能显著抑制炎症因子，改善免疫状态，减轻心肌毒性。瘀血阻滞为发病之标。虚与毒致气血运行无力、血行涩滞，形成瘀血。瘀血又进一步阻碍气血，加重虚、毒，形成恶性循环。活血化瘀法可改善心肌微循环、调节铁死亡通路、抑制异常离子通道活性，提升左心室射血分数，降低心肌损伤标志物。三者最终导致心血管功能受到不可逆损伤。基于上述病机演变，临床提出益气养阴以调节免疫，解毒通络以抑制炎症，活血化瘀以改善循环的综合治法，为防治肿瘤治疗相关性心血管毒性提供思路与用药策略。
Abstract:
Cancer therapy-related cardiovascular toxicity(CTR-CVT) was a significant adverse reaction during anti-tumor treatment and one of the leading causes of death in cancer patients.Its pathogenesis was complex,and modern medicine currently lacks specific preventive or therapeutic measures.This article systematically elaborates on pathogenetic evolution of CTR-CVT based on theory of Deficiency-Toxin-Stasis.These three factors intertwine and influence each other throughout the entire course of the disease.Among them,Qi and Yin deficiency serves as the root cause.Cancer patients inherently have deficient healthy Qi,and anti-tumor drugs,classified as fire-heat toxins,further consume Qi and injure Yin through the principle of using toxins to combat toxins.This leads to lack of heart Qi and depletion of body fluids,manifesting as palpitations,chest tightness,and fatigue.The therapy of supplementing Qi and nourishing Yin can regulate immunity,reduce oxidative stress,and improve mitochondrial function,thereby lowering the incidence of cardiotoxicity induced by anthracyclines and other agents.Toxin-induced damage to the heart meridians was the key pathogenetic link.Accumulation of drug toxins over time damages the heart meridians,leading to myocardial interstitial fibrosis and abnormal cell apoptosis in a dose-dependent manner.These toxins induce vascular endothelial injury and inflammatory responses,while Chinese herbal formulas that clear toxins and unblock meridians can significantly inhibit inflammatory factors,improve immune status,and alleviate myocardial toxicity.Blood stasis obstruction represents the manifestation of the disease.Deficiency and toxin render Qi and blood circulation weak and sluggish,resulting in blood stasis.Blood stasis further obstructs Qi and blood flow,exacerbating deficiency and toxin,thus forming a vicious cycle.The therapy of activating blood circulation and removing stasis can improve myocardial microcirculation,regulate ferroptosis pathways,inhibit abnormal ion channel activity,increase left ventricular ejection fraction,and reduce cardiac injury markers.Eventually,these three factors lead to irreversible damage to cardiovascular function.Based on the above pathogenetic evolution,clinical strategies of supplementing Qi and nourishing Yin to regulate immunity,clearing toxins and unblocking meridians to suppress inflammation,and activating blood circulation and removing stasis to improve circulation are proposed,offering new approaches and medication strategies for the prevention and treatment of CTR-CVT.

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备注/Memo

备注/Memo:
国家自然科学基金资助项目（81603559）；天津市卫生健康委员会中医中西医结合科研课题（2025157）；天津市医学重点学科建设资助项目（TJYXZDXK-3-003A）；河北省中医药管理局科研计划项目（T2025058）；中华中医药学会雏鹰计划中医临床青年人才研修项目（CYJH2024029）
更新日期/Last Update: 2026-08-13