Laviano Alessandro, Meguid Michael M, Rossi-Fanelli Filippo
Department of Clinical Medicine, University La Sapienza, Rome, Italy.
Lancet Oncol. 2003 Nov;4(11):686-94. doi: 10.1016/s1470-2045(03)01247-6.
Anorexia and reduced food intake are important issues in the management of patients with cancer because they contribute to the development of malnutrition, increase morbidity and mortality, and impinge on quality of life. Accumulating evidence indicates that cancer anorexia is multifactorial in its pathogenesis, and most of the hypothalamic neuronal signalling pathways modulating energy intake are likely to be involved. Several factors are considered to be putative mediators of cancer anorexia, including hormones (eg, leptin), neuropeptides (eg, neuropeptide Y), cytokines (eg, interleukin 1 and 6, and tumour necrosis factor), and neurotransmitters (eg, serotonin and dopamine). These pathways are not isolated and distinct pathogenic mechanisms but are closely inter-related. However, convincing evidence suggests that cytokines have a vital role, triggering the complex neurochemical cascade which leads to the onset of cancer anorexia. Increased expression of cytokines during tumour growth prevents the hypothalamus from responding appropriately to peripheral signals, by persistently activating anorexigenic systems and inhibiting prophagic pathways. Hypothalamic monoaminergic neurotransmission may contribute to these effects. Thus, the optimum therapeutic approach to anorectic cancer patients should include changes in dietary habits, achieved via nutritional counselling, and drug therapy, aimed at interfering with cytokine expression or hypothalamic monoaminergic neurotransmission.
厌食和食物摄入量减少是癌症患者管理中的重要问题，因为它们会导致营养不良、增加发病率和死亡率，并影响生活质量。越来越多的证据表明，癌症厌食症的发病机制是多因素的，调节能量摄入的大多数下丘脑神经元信号通路可能都参与其中。几个因素被认为是癌症厌食症的假定介质，包括激素（如瘦素）、神经肽（如神经肽Y）、细胞因子（如白细胞介素1和6以及肿瘤坏死因子）和神经递质（如血清素和多巴胺）。这些通路并非孤立且不同的致病机制，而是密切相关的。然而，有确凿证据表明细胞因子起着至关重要的作用，引发导致癌症厌食症发作的复杂神经化学级联反应。肿瘤生长过程中细胞因子表达的增加，通过持续激活厌食系统和抑制促食欲途径，阻止下丘脑对外周信号做出适当反应。下丘脑单胺能神经传递可能促成了这些效应。因此，针对厌食的癌症患者的最佳治疗方法应包括通过营养咨询改变饮食习惯，以及旨在干扰细胞因子表达或下丘脑单胺能神经传递的药物治疗。
