

浏览全部资源
扫码关注微信
中国医学科学院输血研究所,成都 610052
Received:11 March 2025,
Revised:2025-07-10,
Accepted:11 July 2025,
Published:15 September 2025
移动端阅览
晏晓晨,王宗奎,叶生亮.化疗所致肠黏膜炎的病理机制和治疗策略研究进展[J].中国药房,2025,36(17):2211-2215.
YAN Xiaochen,WANG Zongkui,YE Shengliang.Research progress on the pathological mechanisms and therapeutic strategies of chemotherapy-induced intestinal mucositis[J].ZHONGGUO YAOFANG,2025,36(17):2211-2215.
晏晓晨,王宗奎,叶生亮.化疗所致肠黏膜炎的病理机制和治疗策略研究进展[J].中国药房,2025,36(17):2211-2215. DOI: 10.6039/j.issn.1001-0408.2025.17.22.
YAN Xiaochen,WANG Zongkui,YE Shengliang.Research progress on the pathological mechanisms and therapeutic strategies of chemotherapy-induced intestinal mucositis[J].ZHONGGUO YAOFANG,2025,36(17):2211-2215. DOI: 10.6039/j.issn.1001-0408.2025.17.22.
肠黏膜炎是恶性肿瘤化疗引起的常见并发症之一,严重影响化疗效果并降低患者的生存质量。本文系统综述了化疗所致肠黏膜炎的病理机制,涵盖肠道氧化性、炎症性、细胞凋亡性损伤以及肠道屏障受损和肠道菌群失调等多个方面。同时,本文对当前肠黏膜炎的治疗策略进展进行了全面总结,包括化学药物及复合材料、天然药物、中药复方、生长因子、血液制品干预以及粪菌移植等。未来可加强多学科交叉创新,结合动物模型和大样本临床试验,开发高效低毒的治疗药物以平衡化疗的毒性与抗肿瘤疗效。
Intestinal mucositis is a common complication induced by chemotherapy in malignant tumors, which severely compromises the efficacy of chemotherapy and reduces patients’ quality of life. This article systematically reviews the pathological mechanisms underlying chemotherapy-induced intestinal mucositis, encompassing oxidative damage, inflammatory injury, apoptotic damage, disruption of the intestinal barrier, and intestinal dysbiosis. Additionally, it provides a comprehensive summary of current therapeutic strategies for intestinal mucositis, including chemical agents and composite materials, natural products, compound prescription of traditional Chinese medicine, growth factors, blood products, and fecal microbiota transplantation. Future efforts should strengthen multidisciplinary cross-innovation, integrating animal models and large-scale clinical trials to develop highly effective and low-toxicity therapeutic drugs that balance chemotherapy toxicity and antitumor efficacy.
KNEZEVIC C E , CLARKE W . Cancer chemotherapy:the case for therapeutic drug monitoring [J ] . Ther Drug Monit , 2020 , 42 ( 1 ): 6 - 19 .
CINAUSERO M , APRILE G , ERMACORA P , et al . New frontiers in the pathobiology and treatment of cancer regimen-related mucosal injury [J ] . Front Pharmacol , 2017 , 8 : 354 .
KWON Y . Mechanism-based management for mucositis:option for treating side effects without compromising the efficacy of cancer therapy [J ] . Onco Targets Ther , 2016 , 9 : 2007 - 2016 .
SOUGIANNIS A T , VANDERVEEN B N , DAVIS J M , et al . Understanding chemotherapy-induced intestinal mucositis and strategies to improve gut resilience [J ] . Am J Physiol Gastrointest Liver Physiol , 2021 , 320 ( 5 ): G712 - G719 .
XIAN C J . Roles of growth factors in chemotherapy-induced intestinal mucosal damage repair [J ] . Curr Pharm Biotechnol , 2003 , 4 ( 4 ): 260 - 269 .
CHEUNG E C , VOUSDEN K H . The role of ROS in tumour development and progression [J ] . Nat Rev Cancer , 2022 , 22 ( 5 ): 280 - 297 .
RODRIGUES D , COYLE L , FÜZI B , et al . Unravelling mechanisms of doxorubicin-induced toxicity in 3D human intestinal organoids [J ] . Int J Mol Sci , 2022 , 23 ( 3 ): 1286 .
ARIFA R D N , PAULA T P , MADEIRA M F M , et al . The reduction of oxidative stress by nanocomposite fullerol decreases mucositis severity and reverts leukopenia induced by irinotecan [J ] . Pharmacol Res , 2016 , 107 : 102 - 110 .
COSTA D V S , BON-FRAUCHES A C , SILVA A M H P , et al . 5-fluorouracil induces enteric neuron death and glial activation during intestinal mucositis via a S100B-RAGE-NF-κB-dependent pathway [J ] . Sci Rep , 2019 , 9 ( 1 ): 665 .
ZHENG X H , MAI L T , XU Y , et al . Brucea javanica oil alleviates intestinal mucosal injury induced by chemotherapeutic agent 5-fluorouracil in mice [J ] . Front Pharmacol , 2023 , 14 : 1136076 .
JIN S Z , ZHU T T , DENG S X , et al . Dioscin ameliorates cisplatin-induced intestinal toxicity by mitigating oxidative stress and inflammation [J ] . Int Immunopharmacol , 2022 , 111 : 109111 .
OU Z P , ZHU L J , HUANG C L , et al . Betulinic acid attenuates cyclophosphamide-induced intestinal mucosa injury by inhibiting the NF-κB/MAPK signalling pathways and activating the Nrf2 signaling pathway [J ] . Ecotoxicol Environ Saf , 2021 , 225 : 112746 .
嵇莹莹 , 龚国清 . PI3K/Akt/mTOR通路在炎症相关疾病中分子机制研究进展 [J ] . 药学研究 , 2018 , 37 ( 4 ): 226 - 229 .
ZHANG Q , JIANG F L , TAO J , et al . Effects of Shubu wenshen guchang recipe on intestinal injury and the TLR4/NF-κB signaling pathways in mice with irinotecan-induced delayed-type diarrhea [J ] . Transl Cancer Res , 2022 , 11 ( 9 ): 3250 - 3259 .
KACZMAREK A , BRINKMAN B M , HEYNDRICKX L , et al . Severity of doxorubicin-induced small intestinal mucositis is regulated by the TLR-2 and TLR-9 pathways [J ] . J Pathol , 2012 , 226 ( 4 ): 598 - 608 .
JUSTINO P F C , FRANCO A X , PONTIER-BRES R , et al . Modulation of 5-fluorouracil activation of toll-like/MyD88/NF-κB/MAPK pathway by Saccharomyces boulardii CNCM I-745 probiotic [J ] . Cytokine , 2020 , 125 : 154791 .
LIAO P L , HUANG S H , HUNG C H , et al . Efficacy of azatyrosine-phenylbutyric hydroxamides,a histone deacetylase inhibitor,on chemotherapy-induced gastrointestinal mucositis [J ] . Int J Mol Sci , 2019 , 20 ( 2 ): 249 .
MOSS S F , AGARWAL B , ARBER N , et al . Increased intestinal Bak expression results in apoptosis [J ] . Biochem Biophys Res Commun , 1996 , 223 ( 1 ): 199 - 203 .
SHEN Q , WEI X M , HU J N , et al . Saponins from Platycodon grandiflorum reduces cisplatin-induced intestinal toxicity in mice through endoplasmic reticulum stress-activated a poptosis [J ] . Am J Chin Med , 2022 , 50 ( 7 ): 1927 - 1944 .
KHAN R , KHAN A Q , QAMAR W , et al . Chrysin protects against cisplatin-induced colon toxicity via amelioration of oxidative stress and apoptosis:probable role of p38 MAPK and p53 [J ] . Toxicol Appl Pharmacol , 2012 , 258 ( 3 ): 315 - 329 .
ZHAN Y S , TAN S W , MAO W , et al . Chemotherapy mediates intestinal injury via p53/p53 upregulated modulator of apoptosis (PUMA) signaling pathway [J ] . J Dig Dis , 2014 , 15 ( 8 ): 425 - 434 .
XIE L M , CHEN T , QI X , et al . Exopolysaccharides from genistein-stimulated Monascus purpureus ameliorate cyclophosphamide-induced intestinal injury via PI3K/AKT-MAPKs/NF-κB pathways and regulation of gut microbiota [J ] . J Agric Food Chem , 2023 , 71 ( 35 ): 12986 - 13002 .
CAPDEVILA C , TRIFAS M , MILLER J , et al . Cellular origins and lineage relationships of the intestinal epithelium [J ] . Am J Physiol Gastrointest Liver Physiol , 2021 , 321 ( 4 ): G413 - G425 .
WANG Y R , SUN L , CHEN S W , et al . The administration of Escherichia coli Nissle 1917 ameliorates irinotecan-induced intestinal barrier dysfunction and gut microbial dysbiosis in mice [J ] . Life Sci , 2019 , 231 : 116529 .
WU J Z , GAN Y X , LUO H J , et al . β-patchoulene ameliorates water transport and the mucus barrier in 5-fluorouracil-induced intestinal mucositis rats via the cAMP/PKA/CREB signaling pathway [J ] . Front Pharmacol , 2021 , 12 : 689491 .
SU Y , CHENG S S , DING Y X , et al . A comparison of study on intestinal barrier protection of polysaccharides from Hericium erinaceus before and after fermentation [J ] . Int J Biol Macromol , 2023 , 233 : 123558 .
MAHDY M S , AZMY A F , DISHISHA T , et al . Irinotecan-gut microbiota interactions and the capability of probiotics to mitigate irinotecan-associated toxicity [J ] . BMC Microbiol , 2023 , 23 ( 1 ): 53 .
CHANG C W , LIU C Y , LEE H C , et al . Lactobacillus casei variety rhamnosus probiotic preventively attenuates 5-fluorouracil/oxaliplatin-induced intestinal injury in a syngeneic colorectal cancer model [J ] . Front Microbiol , 2018 , 9 : 983 .
TANG Q J , ZUO T , LU S Y , et al . Dietary squid ink polysaccharides ameliorated the intestinal microflora dysfunction in mice undergoing chemotherapy [J ] . Food Funct , 2014 , 5 ( 10 ): 2529 - 2535 .
FAN Y W , LIANG L C , TANG X Z , et al . Changes in the gut microbiota structure and function in rats with doxorubicin-induced heart failure [J ] . Front Cell Infect Microbiol , 2023 , 13 : 1135428 .
CHEN C Y , TIAN L , ZHANG M Z , et al . Protective effect of amifostine on high-dose methotrexate-induced small intestinal mucositis in mice [J ] . Dig Dis Sci , 2013 , 58 ( 11 ): 3134 - 3143 .
WANG H , ZHU W Z , HONG Y , et al . Astragalus polysaccharides attenuate chemotherapy-induced immune injury by modulating gut microbiota and polyunsaturated fatty acid metabolism [J ] . Phytomedicine , 2024 , 128 : 155492 .
OUYANG M Z , LUO Z T , ZHANG W J , et al . Protective effect of curcumin against irinotecan-induced intestinal mucosal injury via attenuation of NF-κB activation,oxidative stress and endoplasmic reticulum stress [J ] . Int J Oncol , 2019 , 54 ( 4 ): 1376 - 1386 .
MADANI F , KAZEMI S , SHIRAFKAN F , et al . Thymoquinone protects against 5-fluorouracil-induced mucositis by NF-κB and HIF-1 mechanisms in mice [J ] . J Biochem Mol Toxicol , 2023 , 37 ( 9 ): e23405 .
SUN Z G , HU Y Z , WANG Y G , et al . Bupihewei decoction ameliorates 5-FU-induced intestinal mucosal injury in the rats by regulating the TLR-4/NF-κB signaling pathway [J ] . Evid Based Complement Alternat Med , 2019 , 2019 : 5673272 .
CHEN Y L , ZHENG H , ZHANG J Z , et al . Protective effect and potential mechanisms of Wei-changan pill on high-dose 5-fluorouracil-induced intestinal mucositis in mice [J ] . J Ethnopharmacol , 2016 , 190 : 200 - 211 .
WANG J W , KUO C H , KUO F C , et al . Fecal microbiota transplantation:review and update [J ] . J Formos Med Assoc , 2019 , 118 ( Suppl. 1 ): S23 - S31 .
ANTUSHEVICH H . Fecal microbiota transplantation in disease therapy [J ] . Clin Chim Acta , 2020 , 503 : 90 - 98 .
CHANG C W , LEE H C , LI L H , et al . Fecal microbiota transplantation prevents intestinal injury,upregulation of toll-like receptors,and 5-fluorouracil/oxaliplatin-induced toxicity in colorectal cancer [J ] . Int J Mol Sci , 2020 , 21 ( 2 ): 386 .
PETSCHOW B W , CARTER D L , HUTTON G D . In- fluence of orally administered epidermal growth factor on normal and damaged intestinal mucosa in rats [J ] . J Pediatr Gastroenterol Nutr , 1993 , 17 ( 1 ): 49 - 58 .
FARRELL C L , BREADY J V , REX K L , et al . Keratinocyte growth factor protects mice from chemotherapy and radiation-induced gastrointestinal injury and mortality [J ] . Cancer Res , 1998 , 58 ( 5 ): 933 - 939 .
HOWARTH G S . Insulin-like growth factor-Ⅰ and the gastrointestinal system:therapeutic indications and safety implications [J ] . J Nutr , 2003 , 133 ( 7 ): 2109 - 2112 .
DENG L P , ZENG H L , HU X Y , et al . Se@Albumin nanoparticles ameliorate intestinal mucositis caused by cisplatin via gut microbiota-targeted regulation [J ] . Nanoscale , 2021 , 13 ( 25 ): 11250 - 11261 .
覃余燕 , 袁欣 , 张巍 , 等 . 静注人免疫球蛋白对奥沙利铂诱导小鼠脾脏/肠道损伤的救治作用 [J ] . 中国输血杂志 , 2023 , 36 ( 4 ): 279 - 284 .
YAN X C , JIANG P , LI C Q , et al . Intravenous immunoglobulin ameliorates doxorubicin-induced intestinal mucositis by inhibiting the Syk/PI3K/Akt axis and ferroptosis [J ] . Apoptosis , 2025 , 30 ( 3/4 ): 734 - 750 .
THOMSEN M , VITETTA L . Adjunctive treatments for the prevention of chemotherapy- and radiotherapy- induced mucositis [J ] . Integr Cancer Ther , 2018 , 17 ( 4 ): 1027 - 1047 .
SYLVESTER C L , ANDERSON P H , STRINGER A M . New therapeutic strategies for combating gastrointestinal toxicity [J ] . Curr Opin Support Palliat Care , 2020 , 14 ( 2 ): 142 - 152 .
ZHAO X M , FENG X K , YE N , et al . Protective effects and mechanism of coenzyme Q10 and vitamin C on doxorubicin-induced gastric mucosal injury and effects of intestinal flora [J ] . Korean J Physiol Pharmacol , 2021 , 25 ( 4 ): 261 - 272 .
WU Y H , WU J L , LIN Z K , et al . Administration of a probiotic mixture ameliorates cisplatin-induced mucositis and pica by regulating 5-HT in rats [J ] . J Immunol Res , 2021 , 2021 : 9321196 .
QUINTANILHA M F , MIRANDA V C , SOUZA R O , et al . Bifidobacterium longum subsp. longum 5 1A attenua- tes intestinal injury against irinotecan-induced mucositis in mice [J ] . Life Sci , 2022 , 289 : 120243 .
0
Views
9
下载量
0
CSCD
Publicity Resources
Related Articles
Related Author
Related Institution
公网安备50010302001817