黎雪 刘硕 林洪生

摘要 由于抗血管生成靶向药会导致血管内皮损伤的病理生理学机制，促使高血压等心血管疾病成为了最常见的不良反应，防控其发生，对抗肿瘤治疗的完整性、远期生存和生命质量起到重要作用。而中医药不仅能在肿瘤辅助治疗中抗肿瘤血管生成，增加疗效;同时能在高血压防控中改善血管内皮功能进而降压，减少毒性。高血压是血管内皮生长因子（VEGF）抑制剂常见不良反应，但其中医药的防治机制仍尚不明确，而调控VEGF信号转导通路可能是机制之一。现旨在对中医药调控VEGF信号转导通路，结合肿瘤抗血管生成靶向药相关性高血压进行综述，探讨抗血管生成靶向药物相关性高血压的中医药干预防治的分子作用机制，并提出可能解决方案，使肿瘤患者获益。

关键词 中医药;血管内皮生长因子;血管内皮细胞;抗血管生成靶向药;高血压;肿瘤;不良反应;减毒增效

Molecular Mechanism and Research Progress of Traditional Chinese Medicine in the Prevention and Treatment of Anti-Angiogenesis Targeted Drug-Related Hypertension

LI Xue，LIU Shuo，LIN Hongsheng

（Guanganmen Hospital，China Academy of Chinese Medical Sciences，Beijing 100053，China）

Abstract Due to the pathophysiological mechanism of vascular endothelial cell injury caused by anti-angiogenic inhibitors，hypertension and other cardiovascular diseases have become the most common adverse reactions.Prevention and treatment of hypertension play an important role in the integrity of anti-tumor therapy，long-term survival and quality of life.Traditional Chinese medicine（TCM） not only can prevent tumor angiogenesis in tumor adjuvant therapy，but also increase curative effect.Meanwhile，it can improve vascular endothelial function in the prevention and control of hypertension，thereby lowering blood pressure and reducing toxicity.Hypertension is a common adverse reaction of VEGF inhibitors，but the prevention and treatment mechanism is still not clear，and regulation of VEGF signaling pathway may be one of the mechanisms.The purpose of this paper is to review the regulation of VEGF signal transduction pathway by traditional Chinese medicine，combined with tumor anti-angiogenesis targeted drug-related hypertension，and explore the molecular mechanism of traditional Chinese medicine intervention and prevention of hypertension related to anti-angiogenesis targeted drug and propose possible solutions to benefit cancer patients.

Keywords Traditional Chinese medicine; Vascular endothelial growth factor; Vascular endothelial cell; Anti-angiogenic drugs; Hypertension; Cancer; Adverse reactions; Reduce adverse reactions and increase effects

中圖分类号：R242文献标识码：Adoi：10.3969/j.issn.1673-7202.2021.16.026

高血压是许多肿瘤药物治疗的常见不良反应，尤其是抗血管生成靶向药，约1/3的肿瘤患者在治疗中会出现新发高血压[1]。一项安罗替尼Ⅲ期临床研究ALTER0303中，64.63%的患者出现了高血压，39例（13.27%）报告3级高血压，1例（0.34%）4级高血压[2];一项关于贝伐珠单抗荟萃分析显示，高血压发生率为25.3%，3级以上高血压发生率为8.2%[3]。高血压的发生会导致如出血、肾功能衰竭、恶性高血压、左心室功能障碍等严重不良反应，这意味着抗肿瘤治疗的中断。及早诊断并早期强化控制高血压，有助于预防心血管不良事件、可逆性后部脑白质综合征等并发症的发生。……