化疗所致认知障碍机制的研究进展

目的综述目前国内外有关化疗所致认知障碍机制的研究进展。方法应用PubMed、Web of Sience、CNKI和中国生物医学文献数据库检索系统,以＂化疗、认知障碍和机制＂为关键词,检索2008-01-2014-02有关文献,英文文献216篇,中文文献11篇。文章纳入标准：1）化疗所致的认知障碍;2）研究结果中包含认知障碍机制的内容。文章排除标准：1）中枢神经系统原发性或继发性肿瘤所致的认知障碍;2）放疗相关的认知障碍;3）继发于物质滥用的认知障碍。根据纳入排除标准,符合分析的文献46篇。结果化疗相关认知障碍（chemotherapy-related cognitive impairment,CRCI）机制可能涉及以下方面：1）细胞因子的改变;2）化疗药物所致神经细胞的增殖、介导神经细胞的非正常死亡和引发髓鞘的脱失;3）化疗患者其脑结构、脑代谢和脑网络出现的异常现象;4）相关遗传物质的改变。化疗所致认知障碍的混杂因素较多。内分泌治疗对认知的影响机制尚未明确。结论目前单一的机制无法解释化疗所致认知障碍,未来研究可能将集中在量表的标准化制定、随机性前瞻性临床的大样本研究以及基因标志上,这些研究结果将有望进一步明确认知障碍的发生机制,提高癌症患者的生活质量。

Progression of chemotherapy-related cognitive impairment

OBJECTIVE To summarize the recent advances in the mechanism of chemotherapy-related cognitive impairment（CRCI）. METHODS ＂Chemotherpy, cognitive impairment, mechanism＂ were searched as key words in PubMed, Web of Sience, CNKI and China Biology Medicine disc database to obtain related articles from 2008 01 to 2014-02. There were 216 articles in English and 11 in Chinese gained. Inclusion criteria： 1） chemotherapy-related cognitive impairment 2） the aim of the articles to discuss CRCI. Exclusion criteria： 1）cognitive impairment caused by the primary or secondary central nervous system tumor 2）radiotherapy related cognitive impairment 3）cognitive dysfunction secondary to substance abuse. There were 46 articles to be enrolled in this paper according to the criteria. RESULTS The mechanism of CRCI may involve.. 1）CRCI induced by the change of cytokincs; 2）proliferation and accidental death of nerve cell or demyelination caused by chemotherapy; 3）the altered structure or function in brain and the changes of brain network; 4）the change of genetic material caused by chemotherapy. Recently, there are lots of confounding factors among the articles and little is known about the cognitive changes associated with endocrine therapy. CONCLUSIONS CRCI could not be fully explained by single mechanism. Future researches might focus on the development of standardized scale, random clinical studies and genetic markers. It would help to understand the mechanism of CRCI and improve the quality of life for people with cancer in future.