恶性肿瘤患者血清皮质醇激素变化致癌因性疲乏及其机制研究

李忠信; 米登海; 杨芳; 温志震; 刘小荣; 王永祥; 任维维; 李征

doi:10.3969/j.issn.1000-8179.20131634

摘要:

目的探讨恶性肿瘤患者血清皮质醇激素水平变化与癌因性疲乏的相关性及其机制。

方法 80例恶性肿瘤患者分为疲乏组（50例疲乏患者）和非疲乏组（30例非疲乏患者），利用多维疲乏症状量表-简化版（MFSI-SF）和疲劳症状量表（FSI）对患者进行评估。电化学发光法检测血清皮质醇的水平，酶联免疫吸附法测定血清促肾上腺皮质激素（ACTH）的水平，COD-PAP法测定血清胆固醇浓度，双缩脲法测定血清总蛋白、白蛋白浓度，琼脂糖凝胶电泳测定α2-球蛋白比值并计算血清α2-球蛋白浓度。

结果疲乏组患者血清皮质醇水平低于非疲乏组（119.68±5.34）nmol/L vs.（163.45±31.49）nmol/L，P < 0.05，促肾上腺皮质激素水平高于非疲乏组（104.50±17.15）ng/L vs.（51.43±13.24）ng/L，P < 0.05。疲乏组患者MFSI-SF评分与血清皮质醇激素水平呈负相关（r=-0.867，P < 0.001），与血清促肾上腺皮质激素水平呈正相关（r=0.809，P < 0.001）；疲乏组患者FSI评分与血清皮质醇激素水平呈负相关（r=-0.747，P < 0.001），与血清促肾上腺皮质激素水平呈正相关（r=0.701，P < 0.001）。疲乏组患者血清胆固醇（1.25±0.70）mmol/L vs.（3.28±0.73）mmol/L，P < 0.05、白蛋白（18.24±7.03）g/L vs.（37.40±8.05）g/L，P < 0.05和α2球蛋白水平明显低于非疲乏组（2.25±1.07）g/L vs.（5.36±1.09）g/L，P < 0.05。

结论疲乏组患者癌因性疲乏评分增高，而血清皮质醇激素水平降低，促肾上腺皮质激素水平升高；恶性肿瘤患者机体低血清皮质醇激素导致促肾上腺皮质激素紊乱和癌因性疲乏的发生，血清皮质醇激素降低的机制与其合成原料血清胆固醇及其运载蛋白（白蛋白特别是α2球蛋白）降低有关。

Abstract:

Objective To investigate the relationship between cancer-related fatigue and cortisol in cancer patients and elucidate the underlying mechanism.

Methods A total of 80 cancer cases were divided into two groups: fatigue group (50 cases with cancer-related fatigue) and non-fatigue group (30 cases without fatigue). The scores were evaluated through the Multidimensional Fatigue Symptom Inventory-Short Form (MFSI-SF) and the Fatigue Symptom Inventory (FSI) report. Serum specimens were examined through electrochemiluminesence immunoassay and enzyme-linked immunosorbent assay. Serum cholesterol was examined through the CHOD-PAP method, and serum total protein and albumin were determined via the Biuret method. Agarose gel electrophoresis was conducted to determine alpha 2 globulin ratio and to calculate serum alpha 2 globulin concentration.

Results The cortisol level in the fatigue group was significantly lower than that in the non-fatigue group(119.68±5.34) nmol/L vs. (163.45± 31.49) nmol/L, P < 0.05, and the adrenocorticotropic hormone (ACTH) level in the fatigue group was significantly higher than that in the non-fatigue group(104.50 ± 17.15) ng/Lvs. (51.43±13.24) ng/L, P < 0.05. Cortisol negatively correlated with MFSI-SF (r=-0.867, P < 0.001) but positively correlated with ACTH (r=0.809, P < 0.001). Furthermore, cortisol negatively correlated with FSI (r=-0.747, P < 0.001) but positively correlated with ACTH (r=0.70, P < 0.001). The levels of serum cholesterol (1.25±0.70) mmol/L vs. (3.28±0.73) mmol/L, P < 0.05, albumin(18.24 ± 7.03) g/L vs. (37.40 ± 8.05) g/L, P < 0.05, and alpha-2 globulin (2.25±1.07) g/L vs. (5.36±1.09) g/L, P < 0.05were significantly lower in the fatigue group than in the non-fatigue group.

Conclusion The patients with cancer-related fatigue exhibited increased MFSI-SF score, decreased serum cortisol level, and enhanced ACTH level. The low serum cortisol levels caused a disorder in the serumACTH and cancer-related fatigue of malignant tumor patients. The mechanism underlying the reduction in serum cortisol level correlated with the insufficient amounts of serum cholesterol, the composite material of cortisols, and of serum albumin, particularly alpha-2 globulin, the carrier protein of serum cholesterol.

恶性肿瘤患者血清皮质醇激素变化致癌因性疲乏及其机制研究

Relationship between serum cortisol level and cancer-related fatigue