CYTOKINES, THE ACUTE-PHASE RESPONSE, AND RESTING ENERGY-EXPENDITURE IN CACHECTIC PATIENTS WITH PANCREATIC-CANCER
CYTOKINES, THE ACUTE-PHASE RESPONSE, AND RESTING ENERGY-EXPENDITURE IN CACHECTIC PATIENTS WITH PANCREATIC-CANCER
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DOI：
10.1097/00000658-199404000-00001
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发表时间：
1994-04-01
影响因子：
9
通讯作者：
CARTER, DC
中科院分区：
文献类型：
--
作者：
FALCONER, JS;FEARON, KCH;CARTER, DC
目的 确定恶病质胰腺癌患者的静息能量消耗 (REE) 是否增加，并明确肿瘤坏死因子 (TNF) 和白细胞介素 6 (IL-6) 的产生与急性期反应和 REE 的关系。 方法 对 21 名不可切除的胰腺癌患者和 16 名年龄相关对照进行 REE 测量（间接量热法）和身体成分评估（生物电阻抗分析）。使用急性时相蛋白、C反应蛋白以及细胞因子TNF和IL-6评估癌症患者外周血中的全身炎症反应。还测量了体外外周血单核细胞产生的这些细胞因子。结果与对照组相比，胰腺癌患者的 REE 升高（73.4 +/- 5.0 vs. 53.5 +/- 1.6 kcal/kg 体细胞质量；p < 0.003）。具有急性期反应（C 反应蛋白 > 10 mg/L）的癌症患者的静息能量消耗显着高于没有这种反应的癌症患者（85.5 +/- 10.0 [n = 9] vs. 64.3 +/- 3.0 [n = 12] kcal/kg 体细胞质量；p < 0.04）。在任何癌症患者的血清中均未检测到肿瘤坏死因子。检测到血清 IL-6，但在有或没有急性期反应的癌症患者中其水平没有显着差异。相比之下，有急性期反应的癌症患者中分离的外周血单核细胞自发产生的 TNF 和 IL-6 显着高于没有急性期反应的患者（TNF：1231 +/- 244 与 210 +/- 54 pg/ mL/10(5) 细胞；p < 0.001；IL-6：11.5 +/- 1.7 与 3.6 +/- 1.4 ng/mL/10(5) 个细胞，p < 0.003)。 结论 在胰腺癌中，体重减轻的至少一个组成部分是由于 REE 增加。此外，急性期反应的存在表明一组患者代谢明显亢进。 TNF 或 IL-6 的血清浓度与急性期反应的存在无关，而具有此类反应的患者外周血单核细胞产生细胞因子的速率明显更高。这表明局部而非全身细胞因子的产生可能对调节急性期反应很重要。
Objective To determine whether resting energy expenditure (REE) is increased in cachectic patients with pancreatic Cancer and to define the relation of tumor necrosis factor (TNF) and interleukin-6 (IL-6) production to the acute-phase response and to REE.Methods Measurement of REE (indirect calorimetry) and assessment of body composition (bioelectrical impedance analysis) were done in 21 patients with unresectable pancreatic cancer and on 16 age-related controls. The systemic inflammatory response in peripheral blood of the cancer patients was assessed using the acute-phase protein, C-reactive protein, and the cytokines TNF and IL-6. Production of these cytokines by peripheral blood mononuclear cells in vitro was also measured.Results Patients with pancreatic cancer had an elevated REE when compared with controls (73.4 +/- 5.0 vs. 53.5 +/- 1.6 kcal/kg body cell mass; p < 0.003). Resting energy expenditure was significantly greater in cancer patients with an acute-phase response (C-reactive protein > 10 mg/L) than in those who did not have such a response (85.5 +/- 10.0 [n = 9] vs. 64.3 +/- 3.0 [n = 12] kcal/kg body cell mass; p < 0.04). Tumor necrosis factor was not detected in the serum of any of the cancer patients. Serum IL-6 was detected but levels were not significantly different among cancer patients with or without an acute-phase response. In contrast, spontaneous production of TNF and IL-6 by isolated peripheral blood mononuclear cells was significantly greater in cancer patients with an acute-phase response than in those without (TNF: 1231 +/- 244 vs. 210 +/- 54 pg/ mL/10(5) cells; p < 0.001; IL-6: 11.5 +/- 1.7 vs. 3.6 +/- 1.4 ng/mL/10(5) cells, p < 0.003).Conclusions In pancreatic cancer at least a component of weight loss is due to increased REE. Furthermore, the presence of an acute-phase response identifies a group of patients who are markedly hypermetabolic. The serum concentration of TNF or IL-6 does not correlate with the presence of an acute-phase response, whereas rates of cytokine production by peripheral blood mononuclear cells are significantly greater in patients with such a response. This suggests that local rather than systemic cytokine production may be important in regulating the acute-phase response.