Changes in nutritional, functional, and inflammatory markers in advanced pancreatic cancer
Changes in nutritional, functional, and inflammatory markers in advanced pancreatic cancer
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DOI：
10.1207/s15327914nc352_2
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发表时间：
1999-01-01
影响因子：
2.9
通讯作者：
Fearon, KCH
中科院分区：
文献类型：
--
作者：
Barber, MD;Ross, JA;Fearon, KCH
体重减轻和急性期反应与晚期胰腺癌患者的生活质量和生存率差相关;然而，关于这些因素随时间的变化及其相互关系的信息很少。本研究检测了25例仅给予支持性对症治疗的晚期胰腺癌患者的体重、Karnofsky体力状态、C反应蛋白（CRP）和血清白蛋白的变化。大约每月一次对患者进行评估，共70次，允许评估37个间隔的变化。总体而言，患者的中位体重减轻为2.3 kg/28天。在28天内，平均CRP水平上升了15 mg/l，血清白蛋白平均下降了1 g/l。卡诺夫斯基的体能状态每28天下降4分。将评估接近死亡的9名患者与评估接近诊断的13名患者进行比较。死亡后8周内CRP水平的升高以及体重和体能状态的下降明显大于诊断后8周内。在接近诊断的患者中，13%的患者CRP升高，而接近死亡的患者则为100%。在多变量分析中，Karnofsky体能状态与体重减轻百分比和CRP水平显著相关。这些数据进一步暗示急性期蛋白反应与晚期胰腺癌患者中观察到的进行性体重减轻相关。变化似乎加速接近死亡。此外，恶病质的发展与患者功能能力的降低有关。
Weight loss and the acute-phase response have been associated with poor quality of life and survival in advanced pancreatic cancer; however, little information is available on changes in these factors over time and their interrelationships. This study examined changes in weighs, Karnofsky performance status, C-reactive protein (CRP), and serum albumin in 25 patients with advanced pancreatic cancer given supportive symptomatic treatment only. Patients were assessed at approximately monthly intervals on a total of 70 occasions, allowing assessment of changes over 37 intervals. Overall, patients had a median weighs loss of 2.3 kg/28 days. Median CRP levels rose by 15 mg/l, and serum albumin fell by I g/l on average over 28 days. Karnofsky performance status fell by 4 points every 28 days. The nine patients assessed close to death were compared with the 13 assessed close to diagnosis. The increase in CRP level and fall in weight and performance status were significantly greater within eight weeks of death than within eight weeks of diagnosis. Among patients close to diagnosis, 13% had an elevated CRP compared with 100% of those close to death. In multivariate analysis, Karnofsky performance status was significantly associated with percent weight loss and CRP levels. These data further implicate the acute-phase protein response as being associated with the progressive weight loss seen in patients with advanced pancreatic cancer. Changes appear to accelerate close to death. Moreover, the development of cachexia is associated with a reduction in patients' functional capacity.