化疗相关性认知功能损害的研究进展

化疗相关性认知功能损害（chemotherapy-related cognitive impairment,CRCI）是指脑部无原发性或转移性肿瘤的癌症患者在接受化疗期间或化疗后出现的轻微认知功能下降。CRCI的研究开始于20世纪70年代，但直到20世纪90年代国际上才出现对CRCI的一致性重要认识。研究报道CRCI的发生率为16%-75%，症状持续数月到超过20年。目前,有三种方法可以评估认知功能，即神经心理学测验、神经影像学研究和主观评估，但缺乏金标准。CRCI的发生机制在很大程度上仍然是未知的；然而，一些可能的重要机制已经被确认，包括化疗药物的直接神经毒性、DNA损伤与氧化应激、细胞因子、压力与糖皮质激素、雌激素、癌症本身及海马神经发生等。迄今，CRCI缺乏特异、安全且有效的预防和治疗方法。因此，进一步研究CRCI的确切机制及预防或逆转措施至关重要。

Chemotherapy - related cognitive impairment in cancer patients:A systematic review of current research advance

Chemotherapy-related cognitive impairment (CRCI)，a subtle cognitive decline after chemotherapy among cancer patients with non-central nervous system cancers，was described since the 1970s，but significant recognition of CRCI did not emerge with consistency until the late 1990s.Estimates of frequency now range from 16%-75%，and evidence suggests that CRCI may persistent from some months to more than twenty years.Three options to assess cognitive function at present include neuropsychologic testing，neuroimaging studies，and subjective evaluations，although no gold standard currently exists.The mechanisms for CRCI are largely unknown.However，several candidate mechanisms have been identified，which include direct neurotoxicity of chemotherapeutic drugs，DNA damage and oxidative stress，cytokines，stress and glucocorticoid，estrogen，the cancer itself and hippocampal neurogenesis.Treatment options for survivors with cognitive problems are limited because research in this arena is in its infancy.Therefore，further investigation into the exact mechanisms of CRCI，and interventions either to prevent the cognitive problems or to reverse the deficits are crucial.