化疗对肿瘤患者血糖的影响及其防治措施

Influence of Chemotherapy on Blood Glucose in Cancer Patients

肿瘤与糖尿病关系密切,如胰腺癌、结直肠癌、乳腺癌等。肿瘤患者合并糖尿病往往更容易死亡和复发。化疗能够挽救和延长肿瘤患者的生命,而化疗药物、化疗辅助药物、化疗副反应等却可能引起肿瘤患者血糖的波动,诱发或加重糖尿病,甚至出现酮症酸中毒、昏迷、死亡。因而,化疗应在血糖有效控制下进行。化疗引起血糖异常主要与化疗药物的毒性作用、化疗辅助药物引起韵糖代谢紊乱等有关。依据美国2003年新版的化疗毒副作用评价体系CTCAE V3.0,严格监测肿瘤患者化疗期间血糖水平,并采取合适的措施控制高血糖、防护低血糖,使肿瘤患者能够安全顺利地完成肿瘤化疗。目前,血糖控制理想的肿瘤有乳腺癌、结直肠癌、恶性淋巴瘤、肺癌、食管癌等,血糖控制较差的肿瘤有原发性肝癌、胰腺癌等。本文拟就化疗引起血糖异常的有关因素、可能机制及其防治措施作一综述。

There is a close relationship between diabetes and cancer, including but not limited to pancreatic cancer, colorectal cancer, and breast cancer. Cancer patients with diabetes are more vulnerable to death and recurrence. Chemotherapy can prolong the lives of cancer patients, but chemotherapy drugs, chemotherapy supplementary drugs and chemotherapy side effects may all cause fluctuations in blood glucose levels, induce or exacerbate diabetes, and precipitate ketoacidosis, coma and death. Therefore, chemotherapy should be carried out under effective control of blood sugar. Chemotherapy-induced blood sugar abnormalities are mainly related to the toxic effects of chemotherapy drugs and the sugar metabolism disorder induced by chemotherapy supplementary drugs. In order to complete tumor chemotherapy safely and successfully, strict monitoring of blood sugar levels and appropriate measures to control high blood sugar and prevent low blood sugar should be taken according to the 2003 version of the side effects of chemotherapy evaluation system CTCAE V3.0 of the United States. At present, patients with breast cancer, colorectal cancer, malignant lymphoma, lung cancer, and esophageal cancer are under ideal blood glucose control, but poor blood sugar control remains a problem for primary liver cancer patients and pancreatic cancer patients. This paper will summarize the relevant factors of chemotherapy-induced blood glucose abnormalities, possible mechanisms and measures aimed at prevention of chemotherapy-induced blood glucose issues.