麩醯胺酸在改善癌症化放療副作用之口腔黏膜炎的角色

癌症治療引起的口腔黏膜炎
(引用自 Pulito, C., Cristaudo, A., Porta, C.L. et al. J Exp Clin Cancer Res 39, 210 (2020).)

口腔黏膜炎(Mucositis)是常見的癌症治療引起口腔黏膜發炎及潰瘍之副作用，常發生於癌症系統性化療(20-40%)、骨髓移植前的高劑量化療(80%)或頭頸癌放射治療的病患(>95%) [1,2,3,4]。口腔黏膜炎的潰瘍對病患非常痛苦，許多患者需要使用止痛藥物來控制疼痛 [3]，而黏膜損傷造成的劇烈口腔疼痛會引起嚴重的營養不良，導致體重減輕、傷口癒合不良和抗感染能力下降 [5]。採用胃造口管餵食或全胃腸外營養將顯著影響患者生活品質，口腔潰瘍也容易產生繼發性感染，在高劑量化療的免疫抑制患者中容易引發菌血症 [6]。最重要的是，嚴重的口腔黏膜炎可能需要減少化療劑量或中斷放療，甚至會使患者不願意接受治療，進而影響癌症治療成功率。

麩醯胺酸是體內含量最多的游離胺基酸，對於維持消化道黏膜上皮結構的完整性有十分重要的作用 [7]。許多研究已證實麩醯胺酸(Glutamine)可減輕副作用症狀並改善癌症患者的生活品質，包括營養補充及減少黏膜損傷(口腔黏膜炎、咽喉炎、食道炎和腸胃炎) [8]。多國癌症支持性照護學會暨國際口腔腫瘤學會 (MASCC/ISOO) 已發布關於口腔黏膜炎使用麩醯胺酸的臨床指引 [9, 10]。

根據兩項隨機對照試驗(RCT)的結果，建議接受同步化放療的頭頸癌患者使用口服(PO)或含漱麩醯胺酸來預防口腔黏膜炎。在這些研究中，使用麩醯胺酸能顯著降低口腔黏膜炎的嚴重程度、減少口腔黏膜炎的持續時間及相關的疼痛 [11, 12]。而其中一項研究更發現，麩醯胺酸以漱口的形式給予局部作用而不是吞服，可有效降低口腔黏膜炎的嚴重程度和持續時間，也指出麩醯胺酸可經由局部作用吸收後提供的正向幫助 [13]。

目前在所有被指出可改善和/或預防化放療引起的黏膜損傷的氨基酸中，麩醯胺酸的研究是最為深入的。由於其局部吸收的特性，局部給予麩醯胺酸可能會是一種簡單但重要的營養補給方式，在改善癌症治療副作用的同時，幫助癌症患者保持營養目標。

病友們如果發生口腔黏膜炎的症狀時，請務必尋求醫師的專業建議。維持均衡飲食並考慮加強系統性及局部性的營養補充，才能順利完成治療並恢復元氣!

閱讀更多:

放射治療口腔黏膜炎不容忽視- 如何照護與治療

認識頭頸癌治療的副作用- 張口困難/牙關緊閉

參考資料

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