恶性肿瘤能量—营养素代谢治疗新思维

恶性肿瘤或机体产生细胞因子致机体能量—营养素代谢异常,组织利用葡萄糖障碍,胰岛素抵抗;蛋白质代谢呈负氮平衡,瘦组织群下降;脂肪分解和脂肪酸氧化增加。逆转治疗思路应以减少肿瘤负荷为主,联合营养支持、代谢治疗和胃肠功能调理。胰岛素促糖原、脂肪、蛋白质合成,显著改善微量营养素摄取和脂肪代谢,无促肿瘤病程进展证据。ω-3脂肪酸、支链氨基己酸、谷氨酰胺可调控肿瘤患者机体营养代谢。rhGH促蛋白质合成,提高营养物质转换率及肠道钙磷吸收,维护肠屏障,肿瘤临床不应轻易放弃,基于肿瘤细胞GHR表达状态个体化应用可能性或许存在。肿瘤临床常见肠功能障碍、消化吸收障碍、动力障碍和屏障障碍,需要正确认知与合理处置。

Progress on Energy and Nutrient Metabolism in Treatment for Cancer

Cancer-associated malnutrition can result from local effects of tumor and cytokines. It can cause alterations in energy and nutrient metabolism,abnormal glucose utilization,insulin resistance,negative nitrogen balance,decreasing lean mass,increasing lipolysis and fatty acid oxidation. Reversal treatment includes reducing tumor burden,nutritional support,metabolism treatment,recovery of gastrointestinal function. Insulin can increase the synthesis of glycogen,fat,protein and significantly increase micronutrient intakes and fat metabolism. There is no evidence that insulin promotes tumor progression. ω-3 fatty acids,branched-chain amino acid and glutamine may regulate nutrient metabolism in cancer patients. rhGH can promote protein synthesis,improve the conversion rate of nutrients and intestinal absorption of calcium and phosphorus and maintain the intestinal barrier. rhGH should not be given up easily. It may be possible to apply rhGH based on the state of individual tumor cells expressing GH receptor. We should have correct understanding of disorders of bowel function,digestive,absorption,motility,barrier and treat them reasonably.