Falconer J S, Fearon K C, Plester C E, Ross J A, Carter D C
University Department of Surgery, Royal Infirmary of Edinburgh, United Kingdom.
Ann Surg. 1994 Apr;219(4):325-31. doi: 10.1097/00000658-199404000-00001.
To determine whether resting energy expenditure (REE) is increased in cachectic patients with pancreatic cancer and to define the relation of tumor necrosis factor (TNF) and interleukin-6 (IL-6) production to the acute-phase response and to REE.
Measurement of REE (indirect calorimetry) and assessment of body composition (bioelectrical impedance analysis) were done in 21 patients with unresectable pancreatic cancer and on 16 age-related controls. The systemic inflammatory response in peripheral blood of the cancer patients was assessed using the acute-phase protein, C-reactive protein, and the cytokines TNF and IL-6. Production of these cytokines by peripheral blood mononuclear cells in vitro was also measured.
Patients with pancreatic cancer had an elevated REE when compared with controls (73.4 +/- 5.0 vs. 53.5 +/- 1.6 kcal/kg body cell mass; p < 0.003). Resting energy expenditure was significantly greater in cancer patients with an acute-phase response (C-reactive protein > 10 mg/L) than in those who did not have such a response (85.5 +/- 10.0 [n = 9] vs. 64.3 +/- 3.0 [n = 12] kcal/kg body cell mass; p < 0.04). Tumor necrosis factor was not detected in the serum of any of the cancer patients. Serum IL-6 was detected but levels were not significantly different among cancer patients with or without an acute-phase response. In contrast, spontaneous production of TNF and IL-6 by isolated peripheral blood mononuclear cells was significantly greater in cancer patients with an acute-phase response that in those without (TNF: 1231 +/- 244 vs. 210 +/- 54 pg/ml/10(5) cells; p < 0.001; IL-6: 11.5 +/- 1.7 vs. 3.6 +/- 1.4 ng/mL/10(5) cells; p < 0.003).
In pancreatic cancer at least a component of weight loss is due to increased REE. Furthermore, the presence of an acute-phase response identifies a group of patients who are markedly hypermetabolic. The serum concentration of TNF of IL-6 does not correlate with the presence of an acute-phase response, whereas rates of cytokine production by peripheral blood mononuclear cells are significantly greater in patients with such a response. This suggests that local rather than systemic cytokine production may be important in regulating the acute-phase response.
确定胰腺癌恶病质患者静息能量消耗（REE）是否增加，并明确肿瘤坏死因子（TNF）和白细胞介素-6（IL-6）产生与急性期反应及REE的关系。
对21例无法切除的胰腺癌患者和16例年龄匹配的对照者进行REE测量（间接测热法）和身体成分评估（生物电阻抗分析）。使用急性期蛋白C反应蛋白以及细胞因子TNF和IL-6评估癌症患者外周血中的全身炎症反应。还测量了外周血单个核细胞在体外产生这些细胞因子的情况。
与对照组相比，胰腺癌患者的REE升高（73.4±5.0 vs. 53.5±1.6千卡/千克体细胞质量；p<0.003）。有急性期反应（C反应蛋白>10毫克/升）的癌症患者静息能量消耗显著高于无此反应者（85.5±10.0 [n = 9] vs. 64.3±3.0 [n = 12]千卡/千克体细胞质量；p<0.04）。在任何癌症患者血清中均未检测到肿瘤坏死因子。检测到血清IL-6，但有或无急性期反应的癌症患者血清IL-6水平无显著差异。相比之下，有急性期反应的癌症患者分离的外周血单个核细胞自发产生TNF和IL-6的量显著高于无急性期反应者（TNF：1231±244 vs. 210±54皮克/毫升/10⁵细胞；p<0.001；IL-6：11.5±1.7 vs. 3.6±1.4纳克/毫升/10⁵细胞；p<0.003）。
在胰腺癌中，至少部分体重减轻是由于REE增加所致。此外，急性期反应的存在可识别出一组明显高代谢的患者。IL-6的血清TNF浓度与急性期反应的存在无关，而有此反应的患者外周血单个核细胞产生细胞因子的速率显著更高。这表明局部而非全身细胞因子产生可能在调节急性期反应中起重要作用。
