阿霉素(doxorubicin)作为临床广谱抗肿瘤化疗药物,在白血病、乳腺癌和淋巴瘤等多种肿瘤的治疗中发挥关键作用, 但剂量依赖性心肌病是其临床应用的主要限制因素, 严重时可导致心力衰竭, 显著影响肿瘤患者的预后和生活质量。本文系统综述了阿霉素诱导心肌病的核心病理机制, 包括氧化应激与脂质过氧化、线粒体功能障碍、细胞凋亡与坏死、自噬紊乱、能量代谢重编程、炎症反应网络、铁死亡与铜死亡等, 并总结了针对性的防治策略(如靶向抗氧化、线粒体保护、凋亡抑制和自噬调控等), 旨在为阿霉素心肌病的基础研究和临床防治提供系统的理论依据和研究方向。

Doxorubicin is a clinically used broad-spectrum antitumor chemotherapeutic agent that plays a key role in the treatment of various malignancies, including leukemia, breast cancer, and lymphoma. However, its clinical application is largely limited by dose-dependent cardiomyopathy , which can lead to heart failure in severe cases and significantly compromise the prognosis and quality of life of cancer patients. This article systematically reviews the core pathological mechanisms underlying doxorubicin-induced cardiomyopathy, including oxidative stress and lipid peroxidation, mitochondrial dysfunction,apoptosis and necrosis,autophagic dysregulation,energy metabolism reprogramming,inflammatory response network,ferroptosis and cuproptosis. It also summarizes targeted preventive and therapeutic strategies (such as targeted antioxidant therapy, mitochondrial protection, apoptosis inhibition, autophagic regulation). The purpose is to provide a systematic theoretical basis and research directions for the basic research and clinical prevention and treatment of doxorubicin-induced cardiomyopathy.