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【medical-news】《柳叶刀》：放射性暴露可能增加
While the cancer risks associated with radiation are well documented, less is known about the effects on the heart, Dr Parveen Bhatti (National Cancer Institute, Bethesda, MD) and colleagues write.
Study coauthor Dr Kiyohiko Mabuchi (National Cancer Institute) explained to heartwire that the link between high-dose cancer radiotherapy and increased heart disease has long been known. "This has resulted in a substantial reduction, though not total elimination, in cardiac doses from radiotherapy for breast cancer, Hodgkin's lymphoma, etc," he said. "What is new is that recent studies, such as those of Japanese atomic-bomb survivors and patients with benign diseases irradiated at lower doses, have reported an increased CVD risk associated with radiation doses hitherto considered too low to cause cardiovascular effects."
The "most convincing evidence so far," the authors write, is a dose-response study of patients who underwent radiation for peptic-ulcer disease with cardiac radiation doses of 1.6 to 3.9 Gy, which suggested that radiation exposure even lower than the standard "therapeutic" doses can increase cardiovascular risk.
The main barrier to establishing a causal link between radiation and cardiovascular disease--and whether low doses (less than 5 Gy) may damage the heart and circulatory system--is the lack of an "established biological model," Bhatti et al write. But they point out that an inflammatory response to radiation is a "plausible" pathway by which atherosclerosis could develop, although further studies would be needed to address this possibility.
The problem, they note, is that the much smaller relative risk of cardiovascular disease from radiation, as compared with the relative risk of cancer, means that cancer risk will always be the focus, particularly since any bump in CVD is occurring on a high background rate of CVD.
"The low-dose radiation effects on CVD risk are likely to remain challenging and controversial--even more so than the linear no-threshold arguments for cancer risk that are debated to this day--but should not be dismissed," Bhatti et al conclude.
Mabuchi emphasized to heartwire that physicians across disciplines should be aware of the potential radiation risks to the heart. "The effect of low radiation dose on CVD should be a concern for radiation oncologists who are involved in treatment of breast cancer, Hodgkin's lymphoma, and other cancers and for radiologists and cardiologists who are increasingly using interventional radiology and other new techniques--eg, intensity-modulated radiation therapy; these may deliver considerable doses to the heart. The effects of very low doses, as seen in nuclear workers, are still uncertain, as we emphasize in the Comment, but are of potential concern because of the large number of people occupationally exposed to such doses, including medical radiation workers."
Bhatti P, Sigurdson AJ, Mabuchi K. Can low-dose radiation increase risk of cardiovascular disease? Lancet 2008; 372:697-699. 本人已认领该文编译，48小时后若未提交译文，请其他战友自由认领。 认领该文编译，48小时后若未提交译文，请其他战友自由认领。 August 29, 2008 (Bethesda, MD) — Radiation exposure, a well-established risk for cancer, likely also ups the risk of heart disease, radiation researchers write in a Comment in the August 30, 2008 issue of the Lancet [1].
2008年8月29日 — 放射研究人员在2008年8月30日发行的《柳叶刀》杂志的评论专栏指出，放射暴露，这一众所周知的肿瘤危险因素，可能也会增加心脏病的风险。
While the cancer risks associated with radiation are well documented, less is known about the effects on the heart, Dr Parveen Bhatti (National Cancer Institute, Bethesda, MD) and colleagues write.
放射暴露与肿瘤发生风险的关系已经得到充分证实，但它对心脏的影响我们却知之甚少。Parveen Bhatti医生(国家癌症中心，贝塞斯达，MD)和他的同事这样称。
Study coauthor Dr Kiyohiko Mabuchi (National Cancer Institute) explained to heartwire that the link between high-dose cancer radiotherapy and increased heart disease has long been known. "This has resulted in a substantial reduction, though not total elimination, in cardiac doses from radiotherapy for breast cancer, Hodgkin's lymphoma, etc," he said. "What is new is that recent studies, such as those of Japanese atomic-bomb survivors and patients with benign diseases irradiated at lower doses, have reported an increased CVD risk associated with radiation doses hitherto considered too low to cause cardiovascular effects."
该研究的共同作者Kiyohiko Mabuchi 医生(国家癌症中心)对heartwire(心脏网)解释说，很早就已经知道，大剂量肿瘤放疗与心脏病增加存在着联系，“这使得在进行乳癌、何杰金氏淋巴瘤等放疗时，对心脏的照射剂量实质性地减少，虽然还不能完全避免。”他说。“最新的研究提出了新观点，例如在那些日本核爆幸存者和患有良性疾病使用低剂量照射的患者身上，已经发现了与照射剂量有关的CVD风险增加。虽然迄今为止都认为这么低的剂量不会对心血管造成影响。”
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作者:admin@医学,生命科学 2011-03-31 17:11
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