Barber M D, Ross J A, Fearon K C
University Department of Surgery, Royal Infirmary of Edinburgh, Scotland EH3 9YW, Edinburgh, UK.
Surg Oncol. 1999 Nov;8(3):133-41. doi: 10.1016/s0960-7404(99)00045-6.
Cachexia is a common cause of morbidity and mortality in patients with advanced cancer. It is characterised by numerous metabolic abnormalities including inefficient substrate utilisation, alterations in the balance of energy intake and expenditure and the acute-phase protein response. These changes seem to be driven by pro-inflammatory cytokines, alterations of the neuro-endocrine axis and tumour-derived catabolic factors. This results in the loss of both fat and lean tissue. Trials of conventional nutritional supplements in patients with cancer cachexia have failed to show any benefit in terms of weight gain or quality of life and this may be because the ongoing metabolic abnormalities prevent the efficient use of additional calories supplied. A variety of pharmacological agents have been studied in an attempt to normalise these metabolic changes with only limited success. However, it is possible that the combination of an agent to normalise the metabolic milieu along with the provision of additional nutritional support may have the potential to reverse cachexia in advanced cancer.
恶病质是晚期癌症患者发病和死亡的常见原因。其特征是存在多种代谢异常，包括底物利用效率低下、能量摄入与消耗平衡改变以及急性期蛋白反应。这些变化似乎是由促炎细胞因子、神经内分泌轴改变和肿瘤衍生的分解代谢因子驱动的。这导致脂肪和瘦组织均减少。针对癌症恶病质患者的传统营养补充剂试验未能在体重增加或生活质量方面显示出任何益处，这可能是因为持续存在的代谢异常阻碍了对额外提供热量的有效利用。为使这些代谢变化正常化，人们研究了多种药物制剂，但仅取得了有限的成功。然而，使用一种使代谢环境正常化的药物制剂并同时提供额外营养支持，有可能逆转晚期癌症患者的恶病质。
