運用實證探討口服麩醯胺對癌症病人接受化學治療引起的周邊神經病變之成效

Effect of Oral Glutamine on Chemotherapy-Induced Peripheral Neuropathy in Cancer Patients: An Evidence-Based Appraisal

背景：化學治療造成周邊神經病變（chemotherapy-induced peripheral neuropathy, CIPN），嚴重時須減少或停止化療藥物劑量及療程。針對CIPN治療方式無明確指引，口服麩醯胺（glutamine）為方法之一，但價格高且成效及劑量不明確。 目的：確認口服glutamine在CIPN成效。方法：依據PICO（population-intervention-comparison-outcome）的方式來詮釋問題，P為接受化療癌症病人；I為麩醯胺、左旋麩胺酸；C為一般照護；O為緩解、減少或改善CIPN，於Cochrane、 CINAHL、PubMed資料庫檢索，藉實證手法評析三篇隨機分派臨床實驗及兩篇類實驗性研究設計， 並進行成果測量統合分析。 結果：有四篇研究劑量為30克／天，使用時間點為化療開始時或化療後24小時內，時間最短為四天，最長 則連續一至兩個月。glutamine組與對照組在疼痛發生risk ratio = 0.26（95% CI [0.09, 0.70], Z = 2.65, p = .008），顯示glutamine組較對照組少發生疼痛且達顯著差異，而CIPN嚴重度等級、麻木感及肌肉無力在兩組則無明顯差異。從經濟效益來看，病人使用glutamine一天需額外負擔五百元費用，花費高。 結論：實務應用 由於樣本數小，結果呈現疼痛有改善，但費用增加及風險危害未顯著降低，故不主動建議化療病人為預防或改善CIPN症狀而使用口服glutamine。

Background: Chemotherapy may induce peripheral neuropathy, which often results in the chemotherapy dose being reduced or the chemotherapy regimen being stopped. At present, there are no treatment guidelines for chemotherapyinduced peripheral neuropathy. Glutamine is one of the treatment strategies currently applied in practice. This strategy is expensive and lacks clear evidence as to its efficacy. Purpose: To evaluate the effect of oral glutamine on CIPN in cancer patients. Methods: PICO (population- intervention- comparison- outcome) was used to focus the problem: P: cancer patient; I: glutamine, L-glutamine; C: usual care; O: alleviate, reduce, improve, and prevent. Databases searched included Airiti Library, Cochrane Library, CINAHL, and PubMed. Three randomized clinical trials and two quasi-experimental designs were evaluated using evidence-based appraisal. Results: Four studies used 30 g/day of glutamine either at the beginning of chemotherapy or at 24 hours after the beginning of chemotherapy. The shortest duration for taking glutamine was four days and longest duration was two months. The incidences of CIPN-induced pain were significantly different (risk ratio = 0.26; 95% CI [0.09, 0.70], Z = 2.65, p = .008) between the intervention and control groups. The incidences of CIPN grading, numbness, and muscle weakness were not significantly different between the intervention and control groups. From an economic point of view, the clinical efficacy of taking glutamine does not justify the additional daily cost to the patient of NT$500 (about US$17). Conclusions/Implications for Practice: Because of the small sample size, minimal effects of glutamine, and no significant decrease in risk, we do not suggest routinely using oral glutamine to prevent or reduce CIPN symptoms in cancer patients.