Magdalena Celichowska is with the Student's Scientific Group of Department of Endocrinology, Metabolism and Internal Diseases, Poznan University of Medical Sciences, Poznan, Poland.
Miłosz Miedziaszczyk is with the Department of Nephrology, Transplantology and Internal Medicine, Poznan University of Medical Sciences, Poznan, Poland.
J Pain Palliat Care Pharmacother. 2022 Jun;36(2):117-131. doi: 10.1080/15360288.2022.2063469.
Cachexia is a state of increased metabolism associated with high morbidity and mortality. Dysregulation of cytokines and hormone activity causes reduced protein synthesis and excessive protein breakdown. various treatments are available, depending on the primary disease and the patient's state. Besides pharmacological treatment, crucial is nutritional support as well as increasing physical activity. The main purpose of pharmacological treatment is to diminish inflammation, improve appetite and decrease muscle wasting. Therefore a lot of medications aim at proinflammatory cytokines such as Interferon-α or Tumor Necrosis Factor-β, but because of the complicated mechanism of cachexia, the range of targets is very wide. in cachexia treatment, use of corticosteroids is common, which improve appetite, diminish inflammation, inhibit prostaglandin metabolism, Interleukin-1 activity. They can also decrease protein synthesis and increase protein degradation, which can be prevented by resveratrol. Estrogen analogs, progesterone analogs, testosterone analogs, Selective Androgen Receptor Modulators (SARM), Angiotensin-Converting-Enzyme Inhibitors (ACEI), Nonsteroidal anti-inflammatory drugs (NSAIDs), thalidomide, melatonin, Growth Hormone Releasing Peptide-2 (GHRP-2) may play important role in wasting syndrome treatment as well. However, for the usage of some of them, evidence-based recommendations are not available. This review highlights current therapeutic options for cachexia with a specific focus on steroid therapy.
恶病质是一种代谢增加的状态，与高发病率和死亡率有关。细胞因子和激素活性的失调导致蛋白质合成减少和过度蛋白质分解。根据主要疾病和患者的状态，有各种治疗方法可用。除了药物治疗外，营养支持以及增加身体活动也很重要。药物治疗的主要目的是减轻炎症、改善食欲和减少肌肉消耗。因此，许多药物都针对促炎细胞因子，如干扰素-α或肿瘤坏死因子-β，但由于恶病质的复杂机制，靶点范围非常广泛。在恶病质治疗中，常使用皮质类固醇，它可以改善食欲、减轻炎症、抑制前列腺素代谢、白细胞介素-1 活性。它还可以减少蛋白质合成并增加蛋白质降解，而白藜芦醇可以预防这种情况。雌激素类似物、孕激素类似物、睾酮类似物、选择性雄激素受体调节剂（SARM）、血管紧张素转换酶抑制剂（ACEI）、非甾体抗炎药（NSAIDs）、沙利度胺、褪黑素、生长激素释放肽-2（GHRP-2）也可能在消耗综合征治疗中发挥重要作用。然而，对于其中一些药物的使用，还没有基于证据的建议。本综述重点介绍恶病质的当前治疗选择，特别关注类固醇治疗。
