血管生成重塑与急性白血病骨髓 微环境：从机制解析到 靶向治疗策略
Angiogenesis Remodeling and Bone Marrow Microenvironment in Acute Leukemia: From Mechanistic Insights to Targeted Therapeutic Strategies
摘要: 目的：综述急性白血病骨髓微环境血管生成机制及其介导的化疗耐药，探讨抗血管生成治疗策略。方法：检索PubMed等数据库，纳入近年相关文献，从分子通路及治疗策略维度综合分析。结果：白血病细胞经VEGF/VEGFR等通路诱导骨髓异常血管生成，重塑白血病干细胞生态位。不同亚型血管表型异质性显著：FLT3-ITD AML呈动脉减少/静脉增多，T-ALL经PERK-ATF4-JAG1轴破坏造血微环境。血管生成通过细胞黏附、ECM屏障及免疫抑制介导耐药。单药疗效有限，联合治疗具协同潜力；纳米系统可经“血管正常化”逆转耐药。结论：血管生成是急性白血病微环境重塑的核心，未来需借助新技术精准界定治疗窗口，开发个体化联合方案。
Abstract: Objective: To review the mechanisms of angiogenesis in the bone marrow microenvironment of acute leukemia and its mediation of chemoresistance, and to explore anti-angiogenic therapeutic strategies. Methods: Relevant literature published in recent years was retrieved from PubMed and other databases, and comprehensively analyzed from the dimensions of molecular pathways and therapeutic strategies. Results: Leukemia cells induce abnormal angiogenesis in the bone marrow through VEGF/VEGFR and other signaling pathways, thereby remodeling the leukemia stem cell niche. Significant vascular phenotypic heterogeneity exists across different subtypes: FLT3-ITD AML is characterized by reduced arterioles and increased venules, while T-ALL disrupts the hematopoietic microenvironment via the PERK-ATF4-JAG1 axis. Angiogenesis mediates drug resistance through cell adhesion, extracellular matrix barrier formation, and immune suppression. Monotherapy shows limited efficacy, whereas combination therapy demonstrates synergistic potential; nano systems can reverse drug resistance through “vascular normalization”. Conclusion: Angiogenesis is a central driver of microenvironment remodeling in acute leukemia. Future research should utilize novel technologies to precisely define therapeutic windows and develop personalized combination anti-angiogenic regimens.
文章引用：陆天乐. 血管生成重塑与急性白血病骨髓 微环境：从机制解析到 靶向治疗策略[J]. 临床医学进展, 2026, 16(6): 1585-1595. https://doi.org/10.12677/acm.2026.1662373

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