王瀚章,杨兴霞,廖睿,刘婷,汪小刚,黄霞霞,蔡晓庆,景策

• 1:甘肃中医药大学第一临床医学院
• 2:中国人民解放军联勤保障部队第九四〇医院心血管内科

摘要(Abstract)：

放射性冠状动脉疾病（RICAD）是胸部放疗后严重的远期心血管并发症，常见于乳腺癌、肺癌等癌症长期存活患者，潜伏期长达15年，10年发病风险为10%～30%。其病理特征以血管壁纤维增生为主，与典型动脉粥样硬化差异显著，核心发病机制涉及线粒体功能障碍、表观遗传失调、细胞焦亡激活及血管壁纤维化重塑四大通路。治疗领域已从经验用药转向机制导向的精准干预：他汀类药物（优先亲水性类型）为基础治疗，泛醇、钠-葡萄糖协同转运蛋白2抑制剂等新靶点药物展现潜力，卷心菜外泌体样纳米颗粒为药物递送提供新策略；血运重建方面，药物洗脱支架仍是首选，生物可吸收支架为弥漫性病变提供新选择；预防层面，FLASH放疗、调强放疗联合呼吸门控技术可降低心脏辐射损伤，“放疗前评估-术中防护-术后监测”三联模式有效识别并管理高风险患者。未来研究需聚焦基因编辑、细胞焦亡抑制剂开发、特异性生物标志物探索等方向。本文系统综述RICAD的病理机制、预防策略及治疗进展，为临床精准干预提供参考。

关键词(KeyWords)： 放射性冠状动脉疾病;病理机制;靶向治疗;血运重建;预防干预

Abstract:

Keywords:

基金项目(Foundation): 宁夏自然科学基金项目（2022AAC03716）;; 兰州市科技计划项目（2023-ZD-178）

作者(Author): 王瀚章,杨兴霞,廖睿,刘婷,汪小刚,黄霞霞,蔡晓庆,景策

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