Von Roenn J H, Knopf K
Northwestern University Chicago, Illinois, USA.
Oncology (Williston Park). 1996 Jul;10(7):1049-56; discussion 1062-4, 1067-8.
Early intervention and attention to nutritional status are essential in patients with cachexia. Identification of reversible causes of decreased energy intake and/or weight loss is the first step in treatment. When such factors cannot be identified, pharmacologic interventions should be considered. To date, megestrol acetate is the most effective appetite stimulant. Appetite and weight gain occur to a greater and more rapid degree as megestrol dose increases. Unfortunately, the weight gain is due predominantly to an increase in fat mass. Whether this is due to a lack of exercise in the face of increased caloric intake and/or to the hypogonadal effects of megestrol acetate is being tested in ongoing clinical trials. Anabolic agents, particularly growth hormone, are exciting potential therapies. No data are yet available on alternate doses and schedules of growth hormone or on its effect in patients with decreased oral intake. Current studies addressing combination therapy with anabolic agents and appetite stimulants should clarify their respective therapeutic roles.
对于恶病质患者，早期干预和关注营养状况至关重要。识别能量摄入减少和/或体重减轻的可逆原因是治疗的第一步。当无法识别此类因素时，应考虑药物干预。迄今为止，醋酸甲地孕酮是最有效的食欲刺激剂。随着醋酸甲地孕酮剂量增加，食欲和体重增加的程度更大且更迅速。不幸的是，体重增加主要是由于脂肪量增加。目前正在进行的临床试验正在测试这是由于热量摄入增加时缺乏运动和/或醋酸甲地孕酮的性腺功能减退作用所致。合成代谢剂，尤其是生长激素，是令人兴奋的潜在治疗方法。目前尚无关于生长激素的替代剂量和给药方案或其对口服摄入量减少患者的影响的数据。目前针对合成代谢剂与食欲刺激剂联合治疗的研究应阐明它们各自的治疗作用。
