胃肠道癌症患者的恶病质:影响因素、预防和当前的管理方法

O. Grundmann, S. L. Yoon, Joseph J. Williams
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引用次数: 1

摘要

癌症恶病质在癌症晚期患者中非常普遍,并导致更高的死亡风险。对恶病质的延迟管理导致治疗结果不理想和不可逆转地发展为难治性恶病质。本文综述的目的是提供癌症恶病质的病理生理学、具有潜在生物标志物的新诊断标准、预防策略和新的治疗方法。恶病质的特点是存在炎症过程,同时伴有肌肉质量和无意的体重减轻。各种生物标志物,如瘦素、胃饥饿素、TNFα、必需氨基酸、总氨基酸和c反应蛋白都是恶病质的指示物。β-肌营养不良聚糖、肌球蛋白重链和肌营养不良蛋白的循环水平升高是骨骼肌组织分解时生存时间缩短的指标。尽管肌肉萎缩是恶病质的标志,但推荐的恶病质管理仅限于营养咨询和短期服用食欲兴奋剂和皮质类固醇,这往往不能逆转癌症恶病质。使用恶病质分级系统监测体重减轻,以早期发现,阻止难治性恶病质的进展,提高癌症恶病质患者的生存率是至关重要的。
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Cachexia in Patients with Gastrointestinal Cancers: Contributing Factors, Prevention, and Current Management Approaches
Cancer cachexia is highly prevalent among patients with the advanced stage of cancers and leads to a higher risk of mortality. Delayed management of cachexia results in suboptimal treatment outcomes and irreversible progression to refractory cachexia. The purpose of this review is to provide the pathophysiology of cancer cachexia, emerging diagnostic criteria with potential biomarkers, prevention strategies, and novel treatment approaches. Cachexia is characterised by the presence of an inflammatory process in conjunction with muscle mass and unintentional body weight loss. Various biomarkers such as leptin, ghrelin, TNFα, essential amino acids, total amino acids, and C-reactive protein are indicative of cachexia. Increased circulating levels of β-dystroglycan, myosin heavy-chain, and dystrophin are indicators of shortened survival time as skeletal muscle tissues break down. Despite muscle wasting being a hallmark of cachexia, recommended cachexia management is limited to nutritional counselling and administration of an appetite stimulant and corticosteroids for a short period, which often fail to reverse cancer cachexia. It is critical to monitor weight loss using the cachexia grading system for early detection, to halt progression to refractory cachexia and improve the survival of patients with cancer cachexia.
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