Vigano Antonio, Trutschnigg Barbara, Kilgour Robert D, Hamel Nancy, Hornby Laura, Lucar Enriqueta, Foulkes William, Tremblay Michel L, Morais José A
McGill Nutrition and Performance Laboratory, McGill University Health Centre, McGill University, Montreal, Canada.
Clin Cancer Res. 2009 Apr 1;15(7):2442-7. doi: 10.1158/1078-0432.CCR-08-1720. Epub 2009 Mar 3.
Nutritional and functional outcome measures have been shown to vary in patients with chronic diseases according to the polymorphic alleles of angiotensin-converting enzyme (ACE), but little is known about the associations between ACE gene polymorphism (ACEGP) and the components of body composition, strength, and selected blood markers in advanced cancer patients (ACP).
Data were collected from an inception cohort of 172 newly diagnosed ACP with gastrointestinal and non-small cell lung cancer. ACEGP status was defined by the presence of one of the following three combinations of alleles: insertion/insertion, insertion/deletion, and deletion/deletion. Body composition measurements using Dual-energy X-ray Absorptiometry comprised of the following: total fat mass, percent body fat, lean body mass, and appendicular lean mass. Body mass index; handgrip force by Jamar dynamometry; subjective recording of nutrition and performance status as per patient-generated subjective global assessment; cell blood count and differential, serum albumin, ACE, and C-reactive protein were also recorded.
Multiple regression analysis, controlling for gender, age, diagnosis, treatments (radio/chemo), survival, and medication use (ACE inhibitors, anti-inflammatories, statins) revealed the following significant (P </= 0.05) relationships in the insertion/deletion compared with insertion/insertion group: higher hemoglobin (Hb; beta, 6.39 g/dl; 95% confidence interval, 0.01-12.78), lower total fat mass (-5.78 kg; -11.62 to 0.07), percent body fat (-6.04%; -12.20 to 0.12), and lean body mass (-3.26 kg; -6.78 to 0.26). When comparing the DD to the II group, higher serum ACE (9.10; 1.96-16.25), Hb (6.25 g/dl; -0.63 to 13.12), and handgrip force by Jamar (6.85 lbs; 0.78-12.93) were found.
Of the variables studied, ACEGP seems to be primarily associated with differences in body composition, Hb, and muscle strength in ACP. Further data are needed to determine the clinical effect of ACEGP in cancer cachexia.
营养和功能结局指标已被证明在患有慢性疾病的患者中会因血管紧张素转换酶（ACE）的多态性等位基因而有所不同，但对于晚期癌症患者（ACP）中ACE基因多态性（ACEGP）与身体成分、力量及所选血液标志物之间的关联却知之甚少。
数据收集自一个由172例新诊断的患有胃肠道和非小细胞肺癌的ACP患者组成的起始队列。ACEGP状态由以下三种等位基因组合之一的存在来定义：插入/插入、插入/缺失和缺失/缺失。使用双能X线吸收法进行的身体成分测量包括：总脂肪量、体脂百分比、瘦体重和四肢瘦体重。还记录了体重指数；通过Jamar握力计测量的握力；根据患者生成的主观整体评估对营养和体能状态进行的主观记录；血细胞计数及分类、血清白蛋白、ACE和C反应蛋白。
在控制了性别、年龄、诊断、治疗（放疗/化疗）、生存情况和药物使用（ACE抑制剂、抗炎药、他汀类药物）的多元回归分析中，与插入/插入组相比，插入/缺失组呈现出以下显著（P≤0.05）关系：血红蛋白（Hb）水平更高（β，6.39 g/dl；95%置信区间，0.01 - 至12.78），总脂肪量更低（-5.78 kg；-11.62至0.07），体脂百分比更低（-6.04%；-12.20至0.12），以及瘦体重更低（-3.26 kg；-6.78至0.26）。在比较缺失/缺失组与插入/插入组时，发现血清ACE水平更高（9.10；1.96 - 至16.25），Hb水平更高（6.25 g/dl；-0.63至13.12），以及Jamar握力更强（6.85磅；0.78 - 至12.93）。
在所研究的变量中，ACEGP似乎主要与ACP患者的身体成分、Hb和肌肉力量差异相关。需要更多数据来确定ACEGP在癌症恶病质中的临床作用。
