消化道肿瘤患者癌因性疲乏与血清炎性因子及下丘脑-垂体-肾上腺素轴水平的相关性

Correlations between cancer related fatigue and serum inflammatory factors and hypothalamus-pituitary-adrenal axis in patients with gastrointestinal cancer

目的 了解消化道肿瘤患者的疲乏水平,探讨癌因性疲乏（CRF）与血清炎性因子及下丘脑-垂体-肾上腺素（HPA）轴水平的相关性.方法 采用简易疲乏量表评估患者的疲乏水平,采用免疫比浊法测定血清C反应蛋白（CRP）水平,免疫微粒电发光法测定皮质醇水平,酶联免疫吸附试验（ELISA）测量血清中白细胞介素（IL）-6、IL-1β、肿瘤坏死因子-α（TNF-α）、促肾上腺皮质激素（ACTH）和去甲肾上腺素（NE）的水平.结果 消化道肿瘤患者CRF平均总体得分为（3.15±1.93）分,疲乏程度为轻中度,疲乏水平与血清中CRP、TNF-α水平呈明显正相关（r=0.321,P=0.000;r=0.265,P=0.000）,与HPA轴中的NE、ACTH水平呈明显正相关（r=0.174,P=0.015;r=0.257,P=0.000）,与皮质醇水平无关（r=0.033,P=0.652）.美国东部肿瘤协作组（ECOG）得分（t=8.081,P=0.000）、文化程度（t=-4.244,P=0.000）、正在接受的治疗（t=4.563,P=0.000）、自诊断至采血日时间（t=3.453,P=0.001）、CRP（t=2.837,P=0.006）是CRF的重要影响因素.结论 消化道肿瘤患者CRF状况普遍存在,CRF与HPA轴中的NE、ACTH水平呈正相关.医务人员应重视对患者血清中炎性因子及激素水平的测定,改善患者的疲乏状况,提高生命质量.

Objective To investigate the levels of cancer related fatigue （CRF） and the correlations between CRF and serum inflammatory factors and hypothalamus-pituitary-adrenal （HPA） axis in patients with gastrointestinal cancer.Methods The CRF level was assessed by brief fatigue inventory （BFI）.The level of C-reactive protein （CRP） was measured by immunoturbidimetry, and the level of cortisol was measured by electrochemiluminesence.The levels of interleukin （IL）-6, IL-1β, tumor necrosis factor-α （TNF-α）, adrenocorticotropic hormone （ACTH） and norepinephrine （NE） were measured by enzyme-linked immunosorbent assay （ELISA）.Results The average total score of CRF was 3.15＆#177;1.93, and the degree was mild to moderate, which was positively correlated with the CRP （r=0.321, P=0.000）, TNF-α （r=0.265, P=0.000）, NE （r=0.174, P=0.015） and ACTH （r=0.257, P=0.000）, but was not correlated with the cortisol （r=0.033, P=0.652）.Eastern Cooperative Oncology Group （ECOG） score （t=8.081, P=0.000）, education （t=-4.244, P=0.000）, treatment （t=4.563, P=0.000）, time from diagnosis to sampling （t=3.453, P=0.001） and CRP （t=2.837, P=0.006） were important factors of CRF.Conclusion The CRF status is common in gastrointestinal cancer patients.The CRF is correlated with the NE and ACTH of HPA axis.Medical staff should pay attention to the inflammatory factors and hormone levels to improve the fatigue status and the quality of patients.