School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, Northern Ireland.
Centre for Public Health, Queen's University Belfast, Institute of Clinical Science, Royal Victoria Hospital, Belfast, Northern Ireland.
Adv Nutr. 2021 Mar 31;12(2):523-532. doi: 10.1093/advances/nmaa111.
Currently, there are no standardized treatments for cachexia or severe wasting. There is a growing consensus advocating multimodal interventions to address the complex pathogenesis and metabolic alterations in these conditions. This review examined multimodal treatments intended to alleviate and/or stabilize cachexia and severe wasting. The objectives of this review were to 1) identify multimodal interventions for the treatment of cachexia or associated wasting syndromes in patients with a chronic illness, 2) assess the quality of these studies, and 3) assess the effectiveness of multimodal interventions. Electronic databases including PubMed, MEDLINE, EMBASE, Scopus, Web of Science, Cochrane Library, CINAHL, PEDro, OpenGrey, and clinicaltrials.org were systematically searched using both text words and MeSH (medical subject heading) terms. The literature revealed a dearth of large, well-conducted trials in this area. Fourteen trials (n = 5 cancer, n = 5 chronic obstructive pulmonary disease, n = 4 chronic kidney disease) were included in this review. A total of 1026 patients were included across all studies; sample size ranged between 21 and 138 patients. Baseline and follow-up data were collected between 6 wk and 24 mo. All demonstrated some improvement in favor of the treatment groups, in relevant measures of body composition, nutrition, biomarkers, and functionality; however, caution should be applied due to the heterogenous nature of the interventions and small sample sizes. Overall, the evidence from this review supports the role of multimodal interventions in the treatment of severe wasting. However, randomized controlled trials with a powered sample size and sufficiently lengthy interaction period are necessary to assess if multimodal interventions are effective forms of therapy for improving body composition and nutritional and physical status in patients with cachexia and wasting. The protocol for this review is registered with Prospero (ID: CRD42019124374).
目前，对于恶病质或严重消耗症还没有标准化的治疗方法。越来越多的人主张采用多模式干预来解决这些疾病的复杂发病机制和代谢改变。本综述检查了旨在缓解和/或稳定恶病质和严重消耗症的多模式治疗方法。本综述的目的是：1）确定用于治疗慢性疾病患者恶病质或相关消耗综合征的多模式干预措施；2）评估这些研究的质量；3）评估多模式干预的效果。我们系统地检索了包括 PubMed、MEDLINE、EMBASE、Scopus、Web of Science、Cochrane 图书馆、CINAHL、PEDro、OpenGrey 和 clinicaltrials.org 在内的电子数据库，使用文本词和 MeSH（医学主题词）术语。文献表明，该领域缺乏大型、精心设计的试验。本综述纳入了 14 项试验（n = 5 项癌症，n = 5 项慢性阻塞性肺疾病，n = 4 项慢性肾脏病）。所有研究共纳入 1026 例患者；样本量范围为 21 至 138 例。基线和随访数据采集时间为 6 周至 24 个月。所有研究都表明，在身体成分、营养、生物标志物和功能相关的测量指标方面，治疗组都有一定程度的改善；然而，由于干预措施的异质性和样本量小，应谨慎应用这些结果。总的来说，本综述中的证据支持多模式干预在严重消耗症治疗中的作用。然而，需要进行具有足够大样本量和足够长时间干预期的随机对照试验，以评估多模式干预是否是改善恶病质和消耗症患者身体成分以及营养和身体状况的有效治疗方法。本综述的方案已在 PROSPERO（注册号：CRD42019124374）注册。
