左卡尼汀对结直肠癌化疗营养状态及不良反应的影响

doi:10.16689/j.cnki.cn11-9349/r.2020.04.018

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摘要

目的探讨左卡尼汀在结直肠癌患者辅助化疗期间对患者营养状态及不良反应的保护作用。方法将接受mFOLFOX6方案化疗的结直肠癌术后患者随机分为试验组（加用左卡尼汀）及对照组，检测化疗前（T0）、化疗4周期（T1）及8周期（T2）后患者营养指标，血液指标，评估骨髓抑制程度、胃肠道毒性以及外周神经毒性情况，并进行分析。结果T0时两组患者的体质指数（BMI）及外周血中血红蛋白（Hb）、外周血淋巴细胞（PBL）、血清白蛋白（ALB）差异无统计学意义。T1试验组患者的外周血Hb、PBL的含量高于对照组，差异有统计学意义（P<0.05），BMI和ALB的差异无统计学意义（P>0.05），而白细胞计数（WBC）、血小板（PLT）的差异无统计学意义，胃肠道毒性及外周神经毒性差异无统计学意义；T2时试验组患者的外周血Hb、PBL、ALB的含量高于对照组，差异有统计学意义（P<0.05），外周血WBC的差异有统计学意义（P<0.05）。胃肠道毒性的差异有统计学意义（P<0.05），而BMI、外周血PLT的含量以及神经毒性的差异无统计学意义（P>0.05）。结论左卡尼汀在结直肠癌术后患者的辅助化疗期间能较好地维持患者的营养状态，缓解中性粒细胞的减少，且能减少患者的胃肠道毒性，有助于患者治疗的维持。

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	胡刚
	杨建武
	黄镇
	周英豪
	高然
	杨鹤鸣

关键词 ：左卡尼汀, 结直肠癌, 营养状态, 胃肠道毒性, 外周神经毒性

Abstract：

Objective To investigate the protective effect of levocarnitine on nutritional status and adverse reactions in patients with colorectal cancer during adjuvant chemotherapy. Methods Patients with colorectal cancer who received mFOLFOX6 chemotherapy in our department after surgery were randomly divided into the observation group (use levocarnitine) and the control group. Detection (T0), 4 cycles of chemotherapy before the chemotherapy (T1) and 8 cycles (T2) patients after nutrition index, index of blood, the evaluation of degree of bone marrow suppression and gastrointestinal toxicity and peripheral nerve toxicity, and analyzed. Results There was no significant difference in body mass index (BMI), peripheral blood hemoglobin (Hb), peripheral blood lymphocyte (PBL) and serum albumin (ALB) between the two groups at T0. The content of Hb and PBL in peripheral blood of T1 observation group was higher than that of control group, and the difference was statistically significant (P<0.05). The difference between BMI and ALB were not statistically significant (P>0.05). The difference between White blood cell (WBC) and platelet (PLT) was not statistically significant, and the gastrointestinal toxicity and peripheral neurotoxicity were not statistically significant. At T2, the contents of Hb, PBL and ALB in peripheral blood of patients in the observation group were higher than those in the control group, and the differences were statistically significant (P<0.05), while the differences in WBC in peripheral blood were statistically significant (P<0.05). The differences in gastrointestinal toxicity were statistically significant (P<0.05), while the differences in BMI, peripheral blood PLT content and neurotoxicity were not statistically significant (P>0.05). Conclusion Levocarnitine can better maintain the nutritional status of patients, alleviate the reduction of neutrophils, and reduce the gastrointestinal toxicity of patients during adjuvant chemotherapy after colorectal cancer surgery, which is helpful for the maintenance of treatment.

Key words： Levocarnitine Colorectal cancer Nutritional status Gastrointestinal toxicity Peripheral neurotoxicity

通讯作者: 杨鹤鸣，电子邮箱：yhming306@163.com

引用本文:

胡刚，杨建武，黄镇，周英豪，高然，杨鹤鸣. 左卡尼汀对结直肠癌化疗营养状态及不良反应的影响[J]. 肿瘤代谢与营养电子杂志, 2020, 7(4): 469-473.
Hu Gang, Yang Jianwu, Huang Zhen, Zhou Yinghao, Gao Ran, Yang Heming. Effects of levocarnitine on nutritional status and adverse reactions in colorectal cancer patients during adjuvant chemotherapy. Electron J Metab Nutr Cancer, 2020, 7(4): 469-473.

1.DUCREUX M, PETERSEN L N, HLER L, et al. Safety and effectiveness of regorafenib in patients with metastatic colorectal cancer in routine clinical practice in the prospective, observational CORRELATE study［J］. Eur J Cancer, 2019；123:146-154.
2.HAN C H, KILFOYLE D H, HILL A G, et al. Preventing oxaliplatin-induced neurotoxicity: rationale and design of phase Ib randomized, double-blind, placebo-controlled, cross-over trials for early clinical evaluation of investigational therapeutics［J］. Expert Opin Drug Metab Toxicol, 2016, 12(12):1479-1490.
3.PROVENZALE D, GUPTA S, AHNEN D J, et al. NCCN Guidelines Insights: Colorectal Cancer Screening, Version 1.2018［J］. J Natl Compr Canc Netw, 2018, 16(8): 939-949.
4.Jakobsen A, Andersen F, Fischer A, et al. Neoadjuvant chemotherapy in locally advanced colon cancer. A phase II trial［J］. Acta Oncol, 2015, 54(10): 1747-1753.
5.BONHOF C S, POLL-FRANSE L V, VISSERS P A J, et al. Anxiety and depression mediate the association between chemotherapy-induced peripheral neuropathy and fatigue: Results from the population-based PROFILES registry［J］. Psychooncology, 2019, 28(9): 1926-1933.
6.WANG R, WANG LX, ZHANG CSH, et al. L-carnitine ameliorates peripheral neuropathy in diabetic mice with a corresponding increase in insulinlike growth factor1 level［J］. Mol Med Rep, 2019, 19(1): 743-751.
7.BRAMI C, BAO T, DENG G. Natural products and complementary therapies for chemotherapy-induced peripheral neuropathy: A systematic review［J］. Crit Rev Oncol Hematol, 2016, 98: 325-334.
8.RUZZO A, GRAZIANO F, GALLI F, et al. Dihydropyrimidine dehydrogenase pharmacogenetics for predicting fluoropyrimidine-related toxicity in the randomised, phase Ⅲ adjuvant TOSCA trial in high-risk colon cancer patients［J］. Br J Cancer, 2017, 117(9): 1269-1277.
9.GILREATH J A, STENEHJEM D D, RODGERS G M. Diagnosis and treatment of cancer-related anemia［J］. Am J Hematol, 2014, 89(2): 203-12.
10.REUTER S E, EVANS A M. Carnitine and acylcarnitines: Pharmacokinetic, pharmacological and clinical aspects［J］. Clin Pharmacokinet, 2012, 51(9): 553-572.
11.SZEFEL J, KRUSZEWSKI W J, CIESIELSKI M, et al. L-carnitine and cancer cachexia. I. L-carnitine distribution and metabolic disorders in cancer cachexia［J］. Oncol Rep, 2012, 28(1): 319-23.
12.张祎, 易苏红, 蒋芳, 等. PPARα、PPARγ在左卡尼汀改善结肠癌小鼠恶病质中的作用［J］. 胃肠病学, 2013, 18(5): 266-270.
13.MITCHELL T, CLARKE L, GOLDBERG A, et al. Pancreatic cancer cachexia: The role of nutritional interventions［J］. Healthcare (Basel), 2019, 7(3): 89.
14.ESFAHANI M, SAHAFI S, DERAKHSHANDEH A, et al. The anti-wasting effects of l-carnitine supplementation on cancer: experimental data and clinical studies［J］. Asia Pac J Clin Nutr, 2018, 27(3): 503-511.
15.吴丹, 李苏宜. 左卡尼汀干预癌性恶液质能量代谢［J/CD］. 肿瘤代谢与营养电子杂志, 2016, 3(1): 58-62.
16.OKUBO H, ANDO H, ISHIZUKA K, et al. Carnitine insufficiency is associated with fatigue during lenvatinib treatment in patients with hepatocellular carcinoma［J］. PLoS One, 2020, 15(3): e0229772.
17.DEMARQUOY C, DEMARQUOY J. Autism and carnitine: A possible link［J］. World J Biol Chem, 2019, 10(1): 7-16.
18.郎娟娟, 钱兴运, 陶若琳, 等. 左卡尼汀联合氟尿嘧啶对MGC803细胞增殖及凋亡影响的研究［J］. 中国药学杂志, 2016, 51(24): 2102-2108.
19.KRAFT M, KRAFT K, GRTNER S, et al. L-Carnitine-supplementation in advanced pancreatic cancer (CARPAN)--a randomized multicentre trial［J］. Nutr J, 2012, 11: 52.
20.杨鹤鸣, 姜福全, 赵燕, 等. 左卡尼汀防治胃肠肿瘤Folfox6方案化疗不良反应的临床观察［J］. 临床军医杂志, 2015, 43(9):141-142, 146.
21.STEFANO G D, LIONARDO A D, GALOSI E, et al. Acetyl-L-carnitine in painful peripheral neuropathy: A systematic review［J］. J Pain Res, 2019, 12: 1341-1351.
22.朱静娟, 齐卫卫, 邱文生, 等. 左卡尼汀防治胃肠肿瘤LFP方案化疗不良反应的临床观察［J］. 肿瘤研究与临床, 2012, 24(7): 463-465.
23.HERSHMAN D L, UNGER J M, CREW K D, et al. Two-year trends of taxane-induced neuropathy in women enrolled in a randomized trial of Acetyl-L-Carnitine (SWOG S0715) ［J］. J Natl Cancer Inst, 2018, 110(6): 669-676.
24.ASADI M, RAHIMLOU M, SHISHEHBOR F, et al. The effect of l-carnitine supplementation on lipid profile and glycaemic control in adults with cardiovascular risk factors: A systematic review and meta-analysis of randomized controlled clinical trials［J］. Clin Nutr, 2020, 39(1): 110-122.
25.BONOMINI M, LIBERATO L D, ZAMMIT V, et al. Current opinion on usage of L-Carnitine in end-stage renal disease patients on peritoneal dialysis［J］. Molecules, 2019, 24(19):3449.
26.MICIC S, LALIC N, DJORDJEVIC D, et al. Double-blind, randomised, placebo-controlled trial on the effect of l-carnitine and l-acetylcarnitine on sperm parameters in men with idiopathic oligoasthenozoospermia［J］. Andrologia, 2019, 51(6): e13267.