化学疗法所致卵巢损伤的防治研究进展  

Research progress on the prevention and treatment of chemotherapy-induced ovarian damage

作　　者：查雨欣 李阳[1,2] 吕卫国 ZHA Yuxin;LI Yang;LYU Weiguo(Department of Gynecologic Oncology,Women’s Hospital,Zhejiang University School of Medicine,Hangzhou 310006,China;Zhejiang Provincial Clinical Research Center for Obstetrics and Gynecology,Hangzhou 310006,China;Zhejiang Provincial Key Laboratory of Women’s Reproductive Health,Hangzhou 310006,China)

机构地区：[1]浙江大学医学院附属妇产科医院肿瘤科,浙江杭州310006 [2]浙江省妇产疾病临床医学研究中心,浙江杭州310006 [3]浙江省女性生殖健康研究重点实验室,浙江杭州310006

出　　处：《浙江大学学报（医学版）》2024年第3期288-296,共9页Journal of Zhejiang University(Medical Sciences)

基　　金：浙江省尖兵领雁研发攻关计划(2023C03037)。

摘　　要：化学疗法(简称化疗)是治疗恶性肿瘤的重要方法,但其在发挥疗效的同时,也导致许多副作用,包括对女性内分泌和生育能力的影响。除了现存的卵巢保存措施,防治卵巢功能损伤更为关键。化疗致卵巢功能损伤的机制包括卵泡及支持细胞的直接凋亡、卵泡“耗竭效应”、卵巢基质和微血管损伤,并与患者初诊年龄、初始低水平抗米勒管激素、化疗药物毒性和剂量、化疗方案等因素有关。防治卵巢功能损伤的措施包括应用促性腺激素释放激素激动剂或拮抗剂、酪氨酸激酶抑制剂、抗氧化剂、鞘氨醇-1-磷酸、神经酰胺-1-磷酸、哺乳动物雷帕霉素靶蛋白抑制剂、粒细胞集落刺激因子、干细胞疗法和人工卵巢等。本文通过文献综述以期为化疗所致卵巢损伤的防治提供思路和参考。Chemotherapy is a main treatment option for malignant tumors,but it may cause various adverse effects,including dysfunction of female endocrine system and fertility.Chemotherapy-induced ovarian damage has been concerned with ovarian preservation but also the prevention and treatment of ovarian dysfunction.In this article,the mechanisms of ovarian injury caused by chemotherapy,including apoptosis of the follicle and supporting cells,follicle“burn out”,ovarian stromal and microvascular damage;and influencing factors,including age at diagnosis,initial low pre-treatment anti-Müllerian hormone levels,toxicity,dose and regimen of chemotherapy drugs are reviewed based on the latest research results and clinical practice.The article also discusses measures and frontier therapies for the prevention and treatment of ovarian injury,including the application of gonadotropin releasing hormone agonists or antagonists,tyrosine kinase inhibitors,antioxidants,sphingosine-1-phosphate,ceramide-1-phosphate,mammalian target of rapamycin inhibitors,granulocyte-colony stimulating factor,stem cell therapy and artificial ovaries.

关 键 词：化学疗法 卵巢损伤 卵巢保护 机制 综述 

分 类 号：R730.53[医药卫生—肿瘤] R711.75[医药卫生—临床医学]