肿瘤患者高代谢及其机制的研究进展

Research progress of hypermetabolism and its mechanism in tumor patients

恶性肿瘤发生中重度营养不良的发生率非常高,中国肿瘤患者的中度和重度营养不良发生率为58%,营养不良明显影响肿瘤患者的临床结局,近25%的肿瘤患者直接死于营养不良。许多营养不良的肿瘤患者常常表现高静息态能量消耗和高分解代谢。引发这些变化的因素主要包括两个方面:(1)肿瘤负荷;(2)由肿瘤引起的相关因素,包括炎症、神经内分泌紊乱、放化疗、肠道微生态紊乱以及食欲下降和摄入减少等。这些因素交杂在一起并通过尚未完全阐明的复杂机制而激活不同组织器官系统的能量消耗增加、分解代谢增强和合成代谢降低等,从而引起肿瘤患者的营养不良,甚至恶液质。由于引起肿瘤患者营养不良的因素和机制是复杂多样的,因此,肿瘤患者营养治疗也应该是针对性的综合治疗,即在营养不良综合评估和诊断基础上,进行有效综合营养干预和阻断高代谢的药物干预等。本文就肿瘤患者高能耗代谢及其相关机制进行综述。

The incidence of moderate to severe malnutrition in malignant tumors is very high. The latest research shows that the incidence of moderate to severe malnutrition in Chinese tumor patients is 58%. Malnutrition significantly affects the clinical outcome of tumor patients, and nearly 25% of tumor patients die directly from malnutrition. Many malnourished tumor patients often show high resting energy expenditure and hypermetabolism. The factors causing these changes mainly include two aspects:(1)tumor load;(2)the related factors caused by tumor, including inflammation, neuroendocrine disorder, radiotherapy and chemotherapy, intestinal microecological disorder, loss of appetite and intake, etc. These factors are mixed together and activate the increased energy consumption of different tissue and organ systems, enhanced catabolism and decreased anabolism through complex mechanisms that are not fully clarified, resulting in malnutrition in tumor patients. Because the factors and mechanisms causing malnutrition(including cachexia) in tumor patients are complex and diverse, it is necessary to comprehensively evaluate and diagnose malnutrition in tumor patients first, and then carry out effective comprehensive nutritional intervention and drug intervention to block hypermetabolism. This paper reviews the high energy consumption metabolism and its related mechanisms in tumor patients.