多柔比星是临床常用的蒽环类抗肿瘤药物，但其剂量相关性和累积性心脏毒性严重限制了长期应用。丹参Salviae Miltiorrhizae Radix et Rhizoma及其制剂在实验与临床研究中展现出抗多柔比星心脏毒性的潜力。系统回顾了丹参提取物、活性成分（丹参酮I、丹参酮II_A、丹酚酸B等）、复方及中成药通过抑制氧化应激、凋亡、焦亡、炎症等多途径保护心肌的机制。与既往综述主要聚焦单一活性成分或心血管保护作用不同，比较了丹参来源的不同成分在多柔比星心脏毒性中的作用特点及机制差异，并基于当前研究现状，分析临床转化亟待突破的关键瓶颈，为临床应用和药物开发提供参考。

Doxorubicin (DOX) is a widely used anthracycline anticancer agent; however, its dose-dependent and cumulative cardiotoxicity severely limits its long-term clinical use. Danshen (Salviae Miltiorrhizae Radix et Rhizoma) and Salviae Miltiorrhizae Radix et Rhizoma-based preparations have shown potential for the prevention and treatment of DOX-induced cardiotoxicity in both experimental and clinical studies. This review systematically summarizes the cardioprotective mechanisms of Salviae Miltiorrhizae Radix et Rhizoma extracts, active constituents (including tanshinone I, tanshinone II_A, and salvianolic acid B), Salviae Miltiorrhizae Radix et Rhizoma-containing herbal formulas, and Chinese patent medicines, with particular emphasis on their inhibitory effects on oxidative stress, apoptosis, pyroptosis, inflammation, and other pathological processes. Unlike previous reviews that have focused primarily on individual active constituents or the general cardiovascular protective effects of Salviae Miltiorrhizae Radix et Rhizoma, this review compares the pharmacological characteristics and mechanistic differences among different Salviae Miltiorrhizae Radix et Rhizoma-derived components in DOX-induced cardiotoxicity. Based on the current evidence, key barriers to clinical translation are further discussed to provide a reference for the clinical application and drug development of Salviae Miltiorrhizae Radix et Rhizoma-derived therapies.

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四川省医学会科研项目（S2024056）；四川省医学会青年创新项目（Q2025017）；四川省肿瘤医院优秀青年基金（YB2025012）