Smit J M, Mulder N H, Sleijfer D T, Bouman J G, Veeger W
J Cancer Res Clin Oncol. 1986;111(1):59-61. doi: 10.1007/BF00402778.
A number of clinical and chemical parameters related to the gastrointestinal tract in patients treated with intensive chemotherapy for disseminated malignant melanoma were evaluated in order to find quantitative indicators for gastrointestinal toxicity and to investigate the cause of diarrhea after chemotherapy. In 11 patients 17 courses of polychemotherapy with bleomycin, DTIC, vindesine, and actinomycin D were administered, while the patients received complete liquid enteral nutrition. As clinical parameters for toxicity the diarrhea grading system according to the WHO criteria and the daily fecal consistency were used. Furthermore, in the feces Na+, K+, and Cl- (mmol/24 h), Na+/K+ ratio, dry and wet weight (g/24 h), lactate and bile acids (mmol/24 h), fat (g/24 h), pH, and osmolarity were determined. Both clinical parameters were closely correlated. The most important effects of the chemotherapy on the chemical parameters were an increased fecal fluid, K+, and fat excretion. The fecal wet weight and K+ excretion showed a high correlation with the two clinical parameters for gastrointestinal toxicity. We conclude that mucosal injury resulting from chemotherapy probably leads to increased small intestinal fluid and electrolyte secretion inducing diarrhea and that fecal wet weight and K+ excretion are probably the best quantitative indicators for gastrointestincal toxicity.
为了寻找胃肠道毒性的定量指标并探究化疗后腹泻的原因，我们评估了接受强化化疗的播散性恶性黑色素瘤患者的一些与胃肠道相关的临床和化学参数。11例患者接受了17个疗程的包含博来霉素、达卡巴嗪、长春地辛和放线菌素D的联合化疗，同时患者接受全液量肠内营养。作为毒性的临床参数，使用了根据WHO标准的腹泻分级系统和每日粪便稠度。此外，测定了粪便中的Na+、K+和Cl-（mmol/24小时）、Na+/K+比值、干重和湿重（g/24小时）、乳酸和胆汁酸（mmol/24小时）、脂肪（g/24小时）、pH和渗透压。两个临床参数密切相关。化疗对化学参数的最重要影响是粪便液体、K+和脂肪排泄增加。粪便湿重和K+排泄与胃肠道毒性的两个临床参数高度相关。我们得出结论，化疗引起的黏膜损伤可能导致小肠液体和电解质分泌增加从而引发腹泻，并且粪便湿重和K+排泄可能是胃肠道毒性的最佳定量指标。
