美国系统回顾发现口服谷氨酰胺可防治成人癌症患者治疗相关性黏膜炎

　　2016年4月，美国肠外肠内营养学会（ASPEN）官方期刊《营养临床实践》（NCP）正式发表了休斯顿大学药学院、德克萨斯大学MD安德森癌症中心的系统回顾，发现在15项研究中有11项研究提示口服谷氨酰胺可以有效防治成人癌症患者治疗相关性黏膜炎，可以显著减少2、3、4级黏膜炎的发生率和/或减少体重降低以及黏膜炎的持续时间、发生时间和/或最严重程度。最通常的给药方案为30g/d分3次给药，其他方案为7.5～24g/d。谷氨酰胺组与对照组的恶心、呕吐、口干、厌食发生率相似。因此，有必要在接受放化疗的癌症患者中进一步开展大型、随机、安慰剂对照研究。

Nutr Clin Pract. 2016 Apr;31(2):171-9.

Oral Glutamine in Preventing Treatment-Related Mucositis in Adult Patients With Cancer: A Systematic Review.

Sayles C, Hickerson SC, Bhat RR, Hall J, Garey KW, Trivedi MV.

University of Houston College of Pharmacy, Houston, Texas.

University of Texas MD Anderson Cancer Center, Houston, Texas.

BACKGROUND: Breakdown of the mucosal barrier resulting in mucositis is a common adverse event in patients with cancer receiving chemotherapy and radiation. Many studies have evaluated the use of oral glutamine to prevent mucositis in these settings, but current guidelines make no recommendations with regard to its use. Our objective was to systematically review the evidence for the use of oral glutamine in preventing mucositis in adult patients with cancer undergoing chemotherapy and/or radiation.

MATERIALS AND METHODS: A systematic search of English-language literature was done via MEDLINE using the search terms glutamine, cancer, and mucositis or esophagitis or stomatitis. Fifteen studies conducted in adult patients with cancer receiving chemotherapy and/or radiation comparing single-agent oral glutamine with control were identified.

RESULTS: Oral glutamine was shown to be effective in 11 of the 15 studies included in the systematic review. It significantly reduced the incidence of grade 2, 3, or 4 mucositis and/or reduced weight loss as well as the duration, time of onset, and/or maximum grade of mucositis. The most common dosing regimen was 30 g/d in 3 divided doses, with other regimens ranging from 7.5-24 g/d. Rates of nausea, vomiting, dry mouth, and anorexia were similar in the glutamine and control groups.

CONCLUSION: In summary, the favorable efficacy and low toxicity of oral glutamine observed in clinical trials we reviewed provide a strong rationale for large randomized placebo-controlled studies to further evaluate its efficacy in preventing mucositis in patients with cancer receiving chemotherapy and/or radiation.

PMID: 26507188

DOI: 10.1177/0884533615611857