摘要
化疗致周围神经病变（CIPN）是铂类、紫杉醇类、长春碱类化疗药物常见的剂量限制性不良反应。产生外周神经毒性的机制，铂类药物可能与损伤背根神经节有关；紫杉醇类药物可能与抑制微管蛋白解聚和改变轴突运输有关；长春碱类药物可能与抑制蛋白质亚单位缔合成微管导致神经纤维微管缺失和轴突运输障碍有关。弛缓性瘫痪、肌张力降低、肌肉萎缩、腱反射减弱或消失以及局部麻木、灼痛、刺痛、感觉过敏等为CIPN的主要临床表现。在出现CIPN临床症状之前，通常感觉神经动作电位的振幅和传导速度降低，而运动神经动作电位的振幅和传导速度正常或仅出现轻微改变。CIPN的发生与患者性别（女性）、年龄（老年）、生活习惯（吸烟史）、肿瘤类型（卵巢癌）、有基础疾病及联合应用有神经毒性药物有关。化疗累积剂量越大，给药间隔时间越短，CIPN发生率越高。目前尚无有效药物预防CIPN发生，度洛西汀是唯一被美国临床肿瘤学会临床实践指南推荐用于治疗CIPN的药物。
Peripheral neuropathy （CIPN） induced by chemotherapy is the common dose-limiting adverse reactions of platinum, taxol and vinblastine. The mechanisms of CIPN due to platinum, taxol and vinblastine may be related to injury of dorsal root ganglion, inhibition of tubulin depolymerization and changing axonal transport, inhibition of association of tubulin from protein subunit, deletion of tubulin and dysfunction of axonal transport, respectively. Pain, numbness, acanthesthesia, burning sensation, sensory deprivation, myodynamia weakness or paralysation, constipation, sexual dysfunction, change of vision, and anaudia are the main clinical manifestations of CIPN. Usually, the amplitude and the conduction velocity of sensory nerve action potential are decreased, while the amplitude and the conduction velocity of motor nerve are normal or slightly changed before the clinical symptoms of CIPN appearance. The development of CIPN are related with sex （ female ）, age （ agedness ）, habits and customs （ smoking history ）, tumor type （oophoroma）, primary disease and combination with neurotoxie drug. The more the chemotherapeutics accumulated dose is, the higher the incidence of CIPN. The shorter the administration interval of chemotherapy is, the higher the incidence of CIPN. There is no effective drug for prevention of CIPN at present. Duloxetine is the the only one drug recommended by American Society of Clinical Oncology for treatment of CIPN.
出处
《药物不良反应杂志》
CSCD
2015年第4期282-286,共5页
Adverse Drug Reactions Journal
关键词
药物疗法
周围神经损伤
Drug therapy
Peripheral nerve injuries
