CAJ | 학술논문

化疗致周围神经病变（CIPN）是铂类、紫杉醇类、长春碱类化疗药物常见的剂量限制性不良反应。产生外周神经毒性的机制，铂类药物可能与损伤背根神经节有关；紫杉醇类药物可能与抑制微管蛋白解聚和改变轴突运输有关；长春碱类药物可能与抑制蛋白质亚单位缔合成微管导致神经纤维微管缺失和轴突运输障碍有关。弛缓性瘫痪、肌张力降低、肌肉萎缩、腱反射减弱或消失以及局部麻木、灼痛、刺痛、感觉过敏等为 CIPN 的主要临床表现。在出现 CIPN 临床症状之前，通常感觉神经动作电位的振幅和传导速度降低，而运动神经动作电位的振幅和传导速度正常或仅出现轻微改变。CIPN 的发生与患者性别（女性）、年龄（老年）、生活习惯（吸烟史）、肿瘤类型（卵巢癌）、有基础疾病及联合应用有神经毒性药物有关。化疗累积剂量越大，给药间隔时间越短，CIPN 发生率越高。目前尚无有效药物预防 CIPN 发生，度洛西汀是唯一被美国临床肿瘤学会临床实践指南推荐用于治疗CIPN 的药物。
화료치주위신경병변（CIPN）시박류、자삼순류、장춘감류화료약물상견적제량한제성불량반응。산생외주신경독성적궤제，박류약물가능여손상배근신경절유관；자삼순류약물가능여억제미관단백해취화개변축돌운수유관；장춘감류약물가능여억제단백질아단위체합성미관도치신경섬유미관결실화축돌운수장애유관。이완성탄탄、기장력강저、기육위축、건반사감약혹소실이급국부마목、작통、자통、감각과민등위 CIPN 적주요림상표현。재출현 CIPN 림상증상지전，통상감각신경동작전위적진폭화전도속도강저，이운동신경동작전위적진폭화전도속도정상혹부출현경미개변。CIPN 적발생여환자성별（녀성）、년령（노년）、생활습관（흡연사）、종류류형（란소암）、유기출질병급연합응용유신경독성약물유관。화료루적제량월대，급약간격시간월단，CIPN 발생솔월고。목전상무유효약물예방 CIPN 발생，도락서정시유일피미국림상종류학회림상실천지남추천용우치료CIPN 적약물。
Peripheral neuropathy( CIPN)induced by chemotherapy is the common dose-limiting adverse reactions of platinum,taxol and vinblastine. The mechanisms of CIPN due to platinum,taxol and vinblastine may be related to injury of dorsal root ganglion,inhibition of tubulin depolymerization and changing axonal transport,inhibition of association of tubulin from protein subunit,deletion of tubulin and dysfunction of axonal transport,respectively. Pain,numbness,acanthesthesia,burning sensation,sensory deprivation,myodynamia weakness or paralysation,constipation,sexual dysfunction,change of vision,and anaudia are the main clinical manifestations of CIPN. Usually,the amplitude and the conduction velocity of sensory nerve action potential are decreased,while the amplitude and the conduction velocity of motor nerve are normal or slightly changed before the clinical symptoms of CIPN appearance. The development of CIPN are related with sex( female),age( agedness),habits and customs( smoking history),tumor type (oophoroma),primary disease and combination with neurotoxic drug. The more the chemotherapeutics accumulated dose is, the higher the incidence of CIPN. The shorter the administration interval of chemotherapy is,the higher the incidence of CIPN. There is no effective drug for prevention of CIPN at present. Duloxetine is the the only one drug recommended by American Society of Clinical Oncology for treatment of CIPN.