新辅助化疗对肿瘤患者术后认知功能影响的研究进展

doi:10.11958/20253033

天津医药 ›› 2026, Vol. 54 ›› Issue (8): 886-890.doi: 10.11958/20253033

新辅助化疗对肿瘤患者术后认知功能影响的研究进展

胡南¹(), 王捷夫²^,^△()

¹ 天津医科大学肿瘤医院麻醉科，国家恶性肿瘤临床医学研究中心，天津市恶性肿瘤临床医学研究中心，天津市肿瘤防治重点实验室（邮编300060）
² 天津医科大学肿瘤医院结直肠肿瘤科，国家恶性肿瘤临床医学研究中心，天津市恶性肿瘤临床医学研究中心，天津市肿瘤防治重点实验室（邮编300060）

收稿日期:2025-12-25 修回日期:2026-04-10 出版日期:2026-08-15 发布日期:2026-08-07
通讯作者: △E-mail：wangjiefu@tjmuch.com
作者简介:胡南（1987），女，主治医师，主要从事麻醉药物的神经毒性方面研究。E-mail：hunanmazui@163.com
基金资助:
国家自然科学基金青年项目(81701081)

Research advances of the effects of neoadjuvant chemotherapy on postoperative cognitive function in cancer patients

HU Nan¹(), WANG Jiefu²^,^△()

¹ Department of Anaesthesia, Tianjin Medical University Cancer Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
² Department of Colorectal Oncology, Tianjin Medical University Cancer Hospital, National Clinical Research Center for Cancer, Tianjin’s Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China

Received:2025-12-25 Revised:2026-04-10 Published:2026-08-15 Online:2026-08-07
Contact: △E-mail: wangjiefu@tjmuch.com

胡南, 王捷夫. 新辅助化疗对肿瘤患者术后认知功能影响的研究进展[J]. 天津医药, 2026, 54(8): 886-890.

HU Nan, WANG Jiefu. Research advances of the effects of neoadjuvant chemotherapy on postoperative cognitive function in cancer patients[J]. Tianjin Medical Journal, 2026, 54(8): 886-890.

摘要/Abstract

摘要：

新辅助化疗在肿瘤治疗中具有重要价值，但可导致术后认知功能障碍。不同化疗药物的神经毒性存在显著差异，且与剂量呈依赖性关系，尤其对于老年、合并基础疾病等高危人群的影响更为突出。术后认知功能障碍的机制涉及神经炎症、氧化应激、血脑屏障破坏及海马神经发生抑制等多重因素。针对这一问题，需采取多维度干预策略，包括优化化疗方案、应用神经保护剂。未来应聚焦于长期随访、机制探索及精准化干预，以平衡抗肿瘤疗效与认知功能保护，进一步提升患者生存质量。

关键词: 化学疗法, 辅助, 化疗相关认知障碍, 肿瘤, 神经毒性

Abstract:

Neoadjuvant chemotherapy plays a significant role in tumor treatment, but it can lead to postoperative cognitive dysfunction. Studies have shown that the neurotoxicity of different chemotherapy drugs varies significantly and is dose-dependent, especially for high-risk groups such as the elderly and those with underlying diseases.The mechanisms of postoperative cognitive impairment involve multiple factors such as neuroinflammation, oxidative stress, blood-brain barrier disruption and inhibition of hippocampal neurogenesis. To address this issue, multi-dimensional intervention strategies should be adopted, including optimizing chemotherapy regimens and applying neuroprotective agents. Future research should focus on long-term follow-up, mechanism exploration and precise intervention to balance the anti-tumor efficacy and cognitive function protection, and further improve the quality of life of patients.

Key words: chemotherapy, adjuvant, chemotherapy-related cognitive impairment, neoplasms, neurotoxicity

中图分类号:

R453.9

图/表 3

参考文献 37

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药物类别	代表药物	神经毒性表现	对认知功能的影响
烷化剂	环磷酰胺	周围神经病变、可逆性认知障碍	短期记忆减退、注意力分散
抗代谢药	甲氨蝶呤	中枢神经系统毒性（脑膜炎、脑病）	执行功能下降、语言流畅性降低
植物类生物碱	紫杉醇、长春新碱	周围神经病变（感觉异常、疼痛）	精细动作协调障碍，影响认知任务执行
铂类	顺铂、奥沙利铂	周围神经病变（剂量依赖性）、耳鸣	信息处理速度减慢、视觉空间能力下降
蒽环类	阿霉素	较少直接神经毒性，但可通过氧化应激间接影响	可能与长期记忆损害相关

药物类别	代表药物	神经毒性表现	对认知功能的影响
烷化剂	环磷酰胺	周围神经病变、可逆性认知障碍	短期记忆减退、注意力分散
抗代谢药	甲氨蝶呤	中枢神经系统毒性（脑膜炎、脑病）	执行功能下降、语言流畅性降低
植物类生物碱	紫杉醇、长春新碱	周围神经病变（感觉异常、疼痛）	精细动作协调障碍，影响认知任务执行
铂类	顺铂、奥沙利铂	周围神经病变（剂量依赖性）、耳鸣	信息处理速度减慢、视觉空间能力下降
蒽环类	阿霉素	较少直接神经毒性，但可通过氧化应激间接影响	可能与长期记忆损害相关

药物类型	代表药物	作用机制	临床证据等级
抗氧化剂	维生素E、硫辛酸	清除自由基，抑制氧化应激	Ⅱ级（多项 RCT 显示可改善主观认知症状）
神经营养因子	脑源性神经营养因子（BDNF）	促进神经细胞存活与突触可塑性	Ⅲ级（动物实验有效，临床Ⅱ期试验中）
抗炎药物	米诺环素	抑制小胶质细胞过度激活	Ⅱ级（可降低脑脊液IL-6水平，但对认知功能改善证据有限）
胆碱酯酶抑制剂	多奈哌齐	提高脑内乙酰胆碱水平	Ⅱ级（术后短期使用可改善记忆测试成绩）

药物类型	代表药物	作用机制	临床证据等级
抗氧化剂	维生素E、硫辛酸	清除自由基，抑制氧化应激	Ⅱ级（多项 RCT 显示可改善主观认知症状）
神经营养因子	脑源性神经营养因子（BDNF）	促进神经细胞存活与突触可塑性	Ⅲ级（动物实验有效，临床Ⅱ期试验中）
抗炎药物	米诺环素	抑制小胶质细胞过度激活	Ⅱ级（可降低脑脊液IL-6水平，但对认知功能改善证据有限）
胆碱酯酶抑制剂	多奈哌齐	提高脑内乙酰胆碱水平	Ⅱ级（术后短期使用可改善记忆测试成绩）

新辅助化疗对肿瘤患者术后认知功能影响的研究进展

Research advances of the effects of neoadjuvant chemotherapy on postoperative cognitive function in cancer patients

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