Inui Akio
Department of Clinical Molecular Medicine, Kobe University Graduate School of Medicine, Japan.
CA Cancer J Clin. 2002 Mar-Apr;52(2):72-91. doi: 10.3322/canjclin.52.2.72.
Cachexia is among the most debilitating and life-threatening aspects of cancer. Associated with anorexia, fat and muscle tissue wasting, psychological distress, and a lower quality of life, cachexia arises from a complex interaction between the cancer and the host. This process includes cytokine production, release of lipid-mobilizing and proteolysis-inducing factors, and alterations in intermediary metabolism. Cachexia should be suspected in patients with cancer if an involuntary weight loss of greater than five percent of premorbid weight occurs within a six-month period. The two major options for pharmacological therapy have been either progestational agents, such as megestrol acetate, or corticosteroids. However, knowledge of the mechanisms of cancer anorexia-cachexia syndrome has led to, and continues to lead to, effective therapeutic interventions for several aspects of the syndrome. These include antiserotonergic drugs, gastroprokinetic agents, branched-chain amino acids, eicosapentanoic acid, cannabinoids, melatonin, and thalidomide--all of which act on the feeding-regulatory circuitry to increase appetite and inhibit tumor-derived catabolic factors to antagonize tissue wasting and/or host cytokine release. Because weight loss shortens the survival time of cancer patients and decreases performance status, effective therapy would extend patient survival and improve quality of life.
恶病质是癌症最具衰弱性和危及生命的方面之一。恶病质与厌食、脂肪和肌肉组织消耗、心理困扰以及生活质量下降相关，它源于癌症与宿主之间的复杂相互作用。这个过程包括细胞因子的产生、脂质动员和蛋白水解诱导因子的释放以及中间代谢的改变。如果癌症患者在六个月内出现非自愿体重下降超过病前体重的5%，则应怀疑患有恶病质。药物治疗的两种主要选择一直是孕激素类药物，如醋酸甲地孕酮，或皮质类固醇。然而，对癌症厌食 - 恶病质综合征机制的了解已经并将继续导致针对该综合征几个方面的有效治疗干预措施。这些措施包括抗5-羟色胺能药物、促胃肠动力药物、支链氨基酸、二十碳五烯酸、大麻素、褪黑素和沙利度胺——所有这些药物都作用于进食调节回路，以增加食欲并抑制肿瘤衍生的分解代谢因子，从而对抗组织消耗和/或宿主细胞因子释放。由于体重减轻会缩短癌症患者的生存时间并降低身体功能状态，有效的治疗将延长患者的生存期并改善生活质量。
