维生素B12、叶酸及膳食补充剂对乳腺癌化疗所致黏膜炎和中性粒细胞减少的影响。

Effect of vitamin B12, folate, and dietary supplements on breast carcinoma chemotherapy--induced mucositis and neutropenia.

作者信息

Branda Richard F, Naud Shelly J, Brooks Elice M, Chen Zhuan, Muss Hyman

机构信息

Department of Medicine, University of Vermont, Burlington 05401, USA.

出版信息

Cancer. 2004 Sep 1;101(5):1058-64. doi: 10.1002/cncr.20484.

DOI:10.1002/cncr.20484

PMID:15329916

Abstract

BACKGROUND

Although patients with malignant disease frequently use dietary supplements, the effects of these agents with regard to chemotherapy are unclear. Therefore, the authors investigated the influence of vitamin B12, folate, and nutritional supplements on chemotherapy-induced toxicity.

METHODS

Women with breast carcinoma were asked to complete a questionnaire that recorded their use of dietary supplements. Blood samples were obtained for the assessment of serum vitamin B12 and folate levels before and after the first cycle of chemotherapy and for weekly complete blood counts. Toxicity was evaluated by measuring absolute neutrophil counts and the frequency and severity of oral mucositis.

RESULTS

Of the 49 women who submitted questionnaires, 35 (71%) took a combined total of 165 supplements. Compared with patients in a previous study (performed in 1990), patients in the current study had dramatically increased serum folate levels. Initial neutrophil count, but not type of chemotherapy, patient age, or serum vitamin B12 level, was predictive of nadir absolute neutropenia and the decrease from initial neutrophil count to nadir (Nfall). After adjusting for initial neutrophil count, Nfall was found to be lower for women who were taking supplements compared with women who were not taking supplements (P = 0.01) and for women who were taking multivitamins (P = 0.01) or vitamin E (P = 0.03). Women with serum folic acid levels < 20 ng/mL had a smaller decrease in neutrophil count after chemotherapy than did women with higher folate levels (P = 0.04). No significant association between oral mucositis and initial neutrophil count, nadir neutrophil count, Nfall, age, vitamin B12 level, or folate level was found.

CONCLUSIONS

The decrease in neutrophil count caused by chemotherapy was ameliorated by dietary supplementation with a multivitamin or vitamin E. In contrast, high serum folate levels were associated with the exacerbation of this decrease in neutrophil count.

摘要

背景

尽管恶性疾病患者经常使用膳食补充剂，但这些药物对化疗的影响尚不清楚。因此，作者研究了维生素B12、叶酸和营养补充剂对化疗所致毒性的影响。

方法

要求患有乳腺癌的女性填写一份记录其膳食补充剂使用情况的问卷。在化疗的第一个周期前后采集血样，以评估血清维生素B12和叶酸水平，并每周进行全血细胞计数。通过测量绝对中性粒细胞计数以及口腔黏膜炎的频率和严重程度来评估毒性。

结果

在提交问卷的49名女性中，35名（71%）总共服用了165种补充剂。与之前一项研究（于1990年进行）中的患者相比，本研究中的患者血清叶酸水平显著升高。初始中性粒细胞计数可预测最低点绝对中性粒细胞减少以及从初始中性粒细胞计数到最低点的下降幅度（Nfall），而化疗类型、患者年龄或血清维生素B12水平则不能。在调整初始中性粒细胞计数后，发现服用补充剂的女性与未服用补充剂的女性相比，Nfall更低（P = 0.01），服用多种维生素的女性（P = 0.01）或维生素E的女性（P = 0.03）也是如此。血清叶酸水平<20 ng/mL的女性化疗后中性粒细胞计数的下降幅度小于叶酸水平较高的女性（P = 0.04）。未发现口腔黏膜炎与初始中性粒细胞计数、最低点中性粒细胞计数、Nfall、年龄、维生素B12水平或叶酸水平之间存在显著关联。