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

貝克生醫-癌症治療照護全方案左旋麩醯胺酸

參考資料

    1. Logan RM, Al-Azri AR, Bossi P, et al. Systematic review of growth factors and cytokines for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2020;28(5):2485-2498.
    2. Elad S. The MASCC/ISOO mucositis guidelines 2019: The second set of articles and future directions. Support Care Cancer. 2020;28:2445–2447.
    3. Lalla RV, Brennan MT, Gordon SM, Sonis ST, Rosenthal DI, Keefe DM. Oral Mucositis Due to High-Dose Chemotherapy and/or Head and Neck Radiation Therapy. J Natl Cancer Inst Monogr. 2019;2019(53):lgz011.
    4. Sonis ST. Oral mucositis. Anti-Cancer Drugs 2011;22(7):607–12.
    5. Sobue T., Bertolini M., Thompson A., Peterson D.E., Diaz P.I., Dongari-Bagtzoglou A. Chemotherapy-induced oral mucositis and associated infections in a novel organotypic model. Mol. Oral Microbiol. 2018;33:212–223.
    6. Villa A., Sonis S.T. Mucositis: Pathobiology and management. Curr. Opin. Oncol. 2015;27:159–164.
    7. Kim MH, Kim H. The Roles of Glutamine in the Intestine and Its Implication in Intestinal Diseases. Int J Mol Sci. 2017;18(5):1051.
    8. Saunders DP, Rouleau T, Cheng K, et al. Systematic review of antimicrobials, mucosal coating agents, anesthetics, and analgesics for the management of oral mucositis in cancer patients and clinical practice guidelines. Support Care Cancer. 2020;28(5):2473-2484.
    9. Lalla RV, Bowen J, Barasch A, et al. MASCC/ISOO clinical practice guidelines for the management of mucositis secondary to cancer therapy [published correction appears in Cancer. 2015 Apr 15;121(8):1339]. Cancer. 2014;120(10):1453-1461.
    10. Yarom N, Hovan A, Bossi P, et al. Systematic review of natural and miscellaneous agents for the management of oral mucositis in cancer patients and clinical practice guidelines-part 1: vitamins, minerals, and nutritional supplements [published correction appears in Support Care Cancer. 2021 Jul;29(7):4175-4176]. Support Care Cancer. 2019;27(10):3997-4010.
    11. Chattopadhyay S, Saha A, Azam M, Mukherjee A, Sur PK. Role of oral glutamine in alleviation and prevention of radiation-induced oral mucositis: A prospective randomized study. South Asian J Cancer. 2014;3(1):8-12.
    12. Tsujimoto T, Yamamoto Y, Wasa M, et al. L-glutamine decreases the severity of mucositis induced by chemoradiotherapy in patients with locally advanced head and neck cancer: a double-blind, randomized, placebo-controlled trial. Oncol Rep. 2015;33(1):33-39.
    13. Huang EY, Leung SW, Wang CJ, et al. Oral glutamine to alleviate radiation-induced oral mucositis: a pilot randomized trial. Int J Radiat Oncol Biol Phys. 2000;46(3):535-539.
    14. Anderson PM, Lalla RV. Glutamine for Amelioration of Radiation and Chemotherapy Associated Mucositis during Cancer Therapy. Nutrients. 2020 Jun 4;12(6):1675.

  1.  

  1.  

  1.  

  1.  

  1.  

  1.  

  1.  

  1.  

  1.  

  1.  

  1.  

  1.  

  1.  

One thought on “麩醯胺酸在改善癌症化放療副作用之口腔黏膜炎的角色”

發佈留言

發佈留言必須填寫的電子郵件地址不會公開。 必填欄位標示為 *