海南医学2017年9月第28卷第17期 Hainan Med J, Sep. 2017, Vol. 28, No. 17[2] 中华医学会神经病学分会脑血管病学组急性缺血性脑卒中诊治指南撰写组. 中国急性缺血性脑卒中诊治指南2010[S]. 中华神经科杂志, 2010, 43(2): 146-153.[3] Yepes M, Roussel BD,Ali C, et al. Tissue-type plasminogen activatorin the ischemic brain: more than a thrombolytic [J]. Trends Neuro-sci, 2009, 32(1): 48-55.[4] Cinelli P, Madani R, Tsuzuki N, et al. Neuroserpin, a neuroprotectivefactor in focal ischemic stroke [J]. Mol Cell Neurosci, 2001, 18(5):443-457.[5] Yepes M. Tissue-type plasminogen activator is a neuroprotectant inthe central nervous system [J]. Front Cell Neurosci, 2015, 9: 304.[6] Wu F, Wu J, Nicholson AD ,et al. Tissue-type plasminogen activatorregulates the neuronal uptake of glucose in the ischemic brain [J]. JNeurosci, 2012, 32(29): 9848-9858.[7] Wu F, Echeverry R, Wu J, et al. Tissue-type plasminogen activatorprotects neurons from excitotoxin-induced cell death via activationof the ERK1/2-CREB-ATF3 signaling pathway [J]. Mol Cell Neuro-sci, 2013, 52: 9-19.[8] Echeverry R, Wu J, Haile WB, et al. Tissue-type plasminogen activa-tor is a neuroprotectant in the mouse hippocampus [J]. J Clin Invest,2010, 120(6): 2194-2205.[9] Autry AE, Monteggia LM. Brain-derived neurotrophic factor and neu-ropsychiatric disorders [J]. Pharmacol Rev, 2012, 64(2): 238-258.[10] Aas M, Haukvik UK, Djurovic S, et al. BDNF val66met modulatesthe association between childhood trauma, cognitive and brain abnor-malities in psychoses [J]. Prog Europsychopharmacol Biol Psychia-try, 2013, 46: 181-188.(收稿日期：2017-03-23)不同剂量泼尼松方案对晚期胃肠道肿瘤患者癌性疲劳、厌食及营养状态的影响张书勤，马薇，魏柏(武汉市华中科技大学同济医学院附属梨园医院肿瘤科，湖北 武汉 430077)【摘要】 目的 观察不同剂量泼尼松对晚期胃肠道肿瘤患者癌性疲劳、厌食及营养状态的影响。方法 选取梨园医院肿瘤科2013年3月至2016年9月收治的96例晚期肿瘤患者，按随机数字表分为小剂量组(20 mg/d)、大剂量组(40 mg/d)及对照组(最佳姑息支持治疗)，各32例。应用ESAS症状评分系统评估三组用药前及用药2周后的疲劳与厌食情况及血清血红蛋白、白蛋白、总蛋白、前白蛋白、球蛋白等营养学指标，记录两组不良反应发生情况。结果 三组治疗后的ESAS疲劳评分及厌食评分均下降，其中小剂量组与大剂量组治疗后的ESAS疲劳评分分别为(3.34±0.55)分、(3.51±0.61)分，ESAS厌食评分分别为(3.47±0.60)分、(3.52±0.73)分，均低于对照组的(4.61±0.70)分、(4.53±0.65)分，差异均有统计学意义(P<0.05)。小剂量组与大剂量组治疗后的血清血红蛋白、白蛋白、总蛋白、前白蛋白、球蛋白水平均高于本组治疗前及对照组，差异均有统计学意义(P<0.05)。小剂量组不良反应总发生率为18.75%，低于大剂量组的46.88%，差异均有统计学意义(P<0.05)，与对照组的9.38%比较差异无统计学意义(P>0.05)。结论 小剂量泼尼松治疗晚期肿瘤可在有效缓解患者癌性疲劳及厌食症状、改善营养状态的前提下减少不良反应，安全性更高。【关键词】 肿瘤；晚期；癌性厌食；营养状态；泼尼松【中图分类号】 R735 【文献标识码】 A 【文章编号】 1003—6350（2017）17—2786—04Effects of different doses of prednisone on cancer fatigue, anorexia and nutritional status in patients withadvanced gastrointestinal cancer. ZHANG Shu-qin, MA Wei, WEI Bai. Department of Oncology, Wuhan Liyuan HospitalAffiliated to Tongji Medical College of Huazhong University of Science and Technology, Wuhan 430077, Hubei, CHINA【Abstract】 Objective To observe the effects of different doses of prednisone on cancer fatigue, anorexia andnutritional status in patients with advanced gastrointestinal cancer. Methods A total of 96 patients with advanced can-cer were selected and divided into the low-dose group (20 mg/d), the high-dose group (40 mg/d) and the control group(best palliative support) according to the random number table, with 32 cases in each group. The indexes of cancer fatigueand anorexia, serum hemoglobin, albumin, total protein, prealbumin, globulin were measured before and after 2 weeks oftreatment by ESAS symptom scoring system, and the adverse reactions were recorded. Results The ESAS fatiguescores and anorexia scores of the three groups were decreased after the treatment (P<0.05). The ESAS fatigue scoresand anorexia scores of the low-dose group and the high-dose group were (3.34±0.55) points and (3.47±0.60) points,(3.51±0.61) points and (3.52±0.73) points, respectively, which were significantly lower than (4.61±0.70) points and·论 著·doi:10.3969/j.issn.1003-6350.2017.17.011通讯作者：魏柏。E-mail：doctorwb@139.com????????????????????????????????????????????????????????????????????????????????????????????????????????????· ·2786
