当心脏遇上射线:立体定向放射治疗用于治疗肥厚型梗阻性心肌病的前景  

When radiation meets the heart:Future of stereotactic body radiation therapy for hypertrophic obstructive cardiomyopathy

作　　者：廖礼义 汤瀚泽 胡琳 周胜华[1] 李旭平[1] LIAO Liyi;TANG Hanze;HU Lin;ZHOU Shenghua;LI Xuping(Department of Cardiovascular Medicine,Second Xiangya Hospital,Central South University,Changsha 410011,China)

机构地区：[1]中南大学湘雅二医院心血管内科,长沙410011

出　　处：《中南大学学报（医学版）》2023年第12期1914-1919,共6页Journal of Central South University ：Medical Science

基　　金：国家自然科学基金(82150006)。

摘　　要：肥厚型梗阻性心肌病(hypertrophic obstructive cardiomyopathy,HOCM)是一种以心室间隔肥厚和左心室流出道梗阻为主要特征的遗传性心脏疾病。传统的治疗方法(如药物和手术)在部分患者中效果不佳。新型治疗方法(如新型药物和经皮心肌内室间隔射频消融术等)虽有一定进展,但仍需进一步观察其长期效果和安全性。近年来,立体定向放射治疗(stereotactic body radiation therapy,SBRT)作为一种新兴的非侵入性治疗方法用于治疗HOCM,可精确照射心室间隔肥厚区域,对靶区心肌细胞造成直接和间接损伤,从而减轻左心室流出道梗阻和心肌缺血,达到治疗目的。对于药物治疗无效或不适合手术的HOCM患者,SBRT可能为其提供一种新的治疗选择。然而,放射治疗潜在的风险仍然存在,如辐射诱发心脏病(radiation-induced heart disease,RIHD)等。虽然初步研究支持SBRT治疗HOCM的安全性和可行性,但仍需要更多临床研究和长期随访数据去评估其真实的疗效和潜在风险。此外,SBRT治疗HOCM的机制、剂量、疗程、适应证、禁忌证、并发症防治以及如何提高放射治疗的准确性仍需进一步探索,以确定其最佳的治疗策略。Hypertrophic obstructive cardiomyopathy(HOCM)is a hereditary cardiac disorder characterized primarily by septal hypertrophy and left ventricular outflow tract obstruction.Traditional therapeutic modalities,such as medications and surgeries,do not yield satisfactory outcomes in a subset of patients.The advancements have been made in novel treatments,including new drugs and percutaneous intramyocardial septal radiofrequency ablation(PIMSRA),still need further observation to obtain long-term efficacy and safety.In recent years,stereotactic body radiation therapy(SBRT)has emerged as an innovative non-invasive approach for treating HOCM.Studies indicate that SBRT allows for precise targeting of the hypertrophied septal region,causing both direct and indirect damage to targeted myocardial cells.This can alleviate left ventricular outflow tract obstruction and myocardial ischemia,fulfilling the therapeutic objective.For those with HOCM who neither respond well to medications nor are surgical candidates,SBRT offers a potential new therapeutic alternative.However,the latent risks of radiation therapy persist,such as the onset of radiation-induced heart disease(RIHD).The preliminary investigations guarantee the safety and feasibility of SBRT in HOCM management,an increased volume of clinical studies and prolonged follow-up data are essential to evaluate its real efficacy and potential hazards.In addition,research regarding the therapeutic mechanisms of SBRT for HOCM,optimal dosages and treatment durations,indications and contraindications,prevention of complications,and enhancing the precision of radiation therapy,still needs to be further exploration,to determine the best therapeutic strategies.

关 键 词：肥厚型梗阻性心肌病 立体定向放射治疗 无创性 

分 类 号：R542.2[医药卫生—心血管疾病]