Subclinical thiamine deficiency in patients with abdominal cancer
Subclinical thiamine deficiency in patients with abdominal cancer
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DOI：
10.1017/s1478951517000992
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发表时间：
2018-08-01
影响因子：
2.2
通讯作者：
Akechi, Tatsuo
中科院分区：
文献类型：
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作者：
Onishi, Hideki;Ishida, Mayumi;Akechi, Tatsuo
目的硫胺素是人体氧化代谢必需的辅酶；然而，它不能在人体内合成，硫胺素的平均储存能力约为18天。因此，在任何营养不平衡的情况下都可能发生硫胺素缺乏症（TD）。如果不及时治疗，它会导致神经精神疾病韦尼克脑病（WE）。虽然WE是一种医学紧急情况，但它有时被忽视，因为大多数WE患者并不表现出所有的典型症状，包括谵妄、共济失调和眼麻痹。如果没有所有典型的WE临床症状，诊断TD或WE就会变得更加困难。方法从一系列癌症患者中，我们报告了3例无典型临床症状的TD患者。结果69岁女性胰腺癌患者接受紫杉醇联合吉西他滨化疗6个月。她的性能状态（PS）为1。详细的采访显示，她有六个月的食欲不振。另一名69岁的卵巢癌患者接受奈达铂治疗；她的PS是0。详细的采访显示，她有三个月的食欲不振。一名67岁结肠癌女性患者接受ramucirumab联合二线氟尿嘧啶、亚叶酸和伊立替康治疗。她的PS是1。详细的采访显示，她食欲不振了三个星期。没有人表现出典型的WE临床症状，但他们分别出现了6个月、3个月和3周的食欲减退。异常低的血清硫胺素水平支持TD的诊断。本报告强调，即使患者没有出现典型的WE临床症状，癌症患者也有可能发生TD。超过两周的食欲不振可能有助于诊断TD。接受化疗的患者患TD的风险更大。
ObjectiveThiamine is an essential coenzyme for oxidative metabolisms; however, it is not synthesized in the human body, and the average thiamine storage capacity is approximately 18 days. Therefore, thiamine deficiency (TD) can occur in any condition of unbalanced nutrition. If TD is left untreated, it causes the neuropsychiatric disorder Wernicke encephalopathy (WE). Although WE is a medical emergency, it is sometimes overlooked because most patients with WE do not exhibit all of the typical symptoms, including delirium, ataxia, and ophthalmoplegia. If all of the typical clinical symptoms of WE are absent, diagnosis of TD or WE becomes more difficult.MethodFrom a series of cancer patients, we reported three patients who developed TD without the typical clinical symptoms of WE.ResultA 69-year-old woman with pancreatic body cancer receiving chemotherapy with paclitaxel and gemcitabine for six months. Her performance status (PS) was 1. A detailed interview revealed that she had appetite loss for six months. Another 69-year-old woman with ovarian cancer received nedaplatin; her PS was 0. A detailed interview revealed that she had appetite loss for three months. A 67-year-old woman with colon cancer receiving ramucirumab in combination with second-line fluorouracil with folinic acid and irinotecan. Her PS was 1. A detailed interview revealed that she had appetite loss for three weeks. None exhibited typical clinical signs of WE, but they developed appetite loss for six months, three months, and three weeks, respectively. The diagnosis of TD was supported by abnormally low serum thiamine levels.Significance of the resultsThis report emphasizes the possibility of TD in cancer patients even when patients do not develop typical clinical signs of WE. The presence of appetite loss for more than two weeks may aid in diagnosing TD. Patients receiving chemotherapy may be at greater risk for developing TD.