Survival of children with cancers has improved significantly over the past five decades, with an increase in the 5-year survival from less than half in the 1960s to more than 80% in the present era. Nonetheless, the use of chemotherapeutic agents, in particular anthracyclines, in the treatment of childhood cancers is associated with an increased risk of cardiac dysfunction in the long-term.
因此，从长远来看，先前的研究集中在监测心脏功能和鉴定与心脏异常功能相关的危险因素。但是，关于血管功能的数据很少，这些数据构成了我们身体循环系统的另一个重要组成部分。
最近的大规模流行病学研究不仅表明，儿童期癌症成年幸存者的心力衰竭风险增加，而且还出现了与心脏和大脑有关的血管事件的发生。重要的是，在相对年轻的成年幸存者中发展心血管和脑血管事件的几率增加意味着动脉血管功能异常的可能性。
Our study
重点our study是为了确定蒽环类药物治疗的儿童癌的年轻成人幸存者的动脉结构和功能。此外，我们确定了运动应力期间动脉的功能反应，并确定了与动脉结构和功能改变有关的因素。这项研究在临床上具有相关性，因为心脏的最佳性能不仅取决于其内在的收缩和松弛特性，还取决于其与血管的相互作用。
We found that about one-third of the 96 young adult survivors of childhood cancers, when studied at a mean age of 25 years, had increased intima-media thickness of the carotid arteries compared with healthy age-matched subjects. Importantly, arterial intima-media thickness is regarded as a surrogate marker of atherosclerosis.
This finding has clinical significance given the long follow-up duration of 15 years of our survivors since their completion of therapy and that the majority (95%) of the survivors had not received head and neck irradiation, which is a known risk factor for vascular damage. Additionally, we found stiffening of the arteries in survivors and its augmentation during exercise stress. Augmentation of arterial stiffness during exercise possibly reflects underlying structural changes of the blood vessel wall.
我们的发现具有几种临床意义。首先，动脉的僵硬可能会增强心脏功能障碍的发育，因为心脏需要泵送更大的阻力。其次，动脉僵硬是增加高血压风险的预兆。第三，我们的数据表明，与健康受试者相比，与幸存者相比，与幸存者年龄相比，运动过程中颈动脉内膜膜厚度的增加和动脉僵硬的增强坡度更高，这表明儿童癌症成人成人幸存者的可能性过早血管老化的可能性。
Looking to the future
The rapidly developing field of pediatric cardio-oncology would hopefully lead to the generation of evidence-based guidelines on cardiovascular surveillance of pediatric cancer patients. The findings of the present study suggest the need for longitudinal monitoring of not only the cardiac but also vascular toxicities of cancer therapy in children. Further prospective studies to explore the consequences of premature vascular aging and abnormal interaction between the arteries and the heart in this at risk population are warranted.
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