为了给肿瘤难治性恶液质的维生素和微量元素临床诊疗提供参考，本文通过文献检索，对肿瘤难治性恶液质患者 显著改变的几种维生素和微量元素代谢及其治疗进行了综述。研究表明，肿瘤难治性恶液质患者常常发生维生素或微量元素 代谢改变，如维生素B1缺乏引起的韦尼克脑病、维生素B12缺乏症或功能性维生素B12缺乏症、维生素C缺乏症、临床或亚临床 维生素K缺乏症、血清维生素D水平低下、缺铁性贫血，以及锌缺乏引起的出血时间延长等，其发生原因与维生素和微量元素 摄入不足和/或储备减少、肿瘤引起的异常代谢有关。补充维生素B1可有效缓解韦尼克脑病引起的谵妄，补充维生素B12可改 善因维生素B12缺乏或功能性缺乏引起的神经功能障碍，补充维生素C有助于改善患者的整体状况及生活质量，补充维生素K 可降低因维生素K缺乏或功能性缺乏引起的出血风险。当患者血清维生素D水平较低并伴有疼痛时，可尝试补充维生素D3以 减少阿片类药物剂量。当患者铁蛋白升高但其他参数表明其存在缺铁性贫血时，可尝试铁替代治疗，但需密切监测铁剂促进 肿瘤生长的不良影响。当晚期肿瘤患者凝血功能异常只表现为出血时间延长时，可尝试补充锌剂治疗。总之，肿瘤难治性恶 液质患者是维生素和微量元素缺乏症的高发人群，对有症状或怀疑某种维生素/微量元素缺乏的患者，应给予诊断和治疗。

In order to provide reference for the clinical diagnosis and treatment of vitamins and trace elements in patients with tumor⁃refractory cachexia, this article reviewed the metabolism and treatment of several vitamins and trace elements in patients with refractory cachexia through literature search. Studies have found that patients with tumor⁃refractory cachexia often have changes in the metabolism of vitamins or trace elements, such as Wernicke encephalopathy caused by vitamin B1 deficiency, vitamin B12 deficiency or functional vitamin B12 deficiency, vitamin C deficiency, clinical or subclinical vitamin K deficiency, low serum vitamin D level, iron deficiency anemia, and prolonged bleeding time caused by zinc deficiency, etc., these are caused by insufficient intake and/or reduced reserves, and abnormal metabolism caused by tumors. Vitamin B1 supplementation can effectively alleviate delirium caused by Wernicke encephalopathy, vitamin B12 supplementation can improve neurological dysfunction caused by vitamin B12 deficiency or functional deficiency, vitamin C supplementation can help improve the patient's overall condition and quality of life, and vitamin K supplementation can reduce the risk of bleeding caused by vitamin K deficiency or functional deficiency. When the patient's serum vitamin D level is low and accompanied by pain, vitamin D3 supplementation can be tried to reduce the dose of opioids. When the patient's ferritin is elevated but other parameters indicate the presence of iron deficiency anemia, iron replacement therapy can be tried, but it is necessary to closely monitor the adverse effects of iron on promoting tumor growth. When the coagulation function of patients with advanced tumors is only manifested as prolonged bleeding time, zinc supplementation can be tried. In short, patients with tumor refractory cachexia are high⁃risk groups of vitamin and trace element deficiencies. Patients with symptoms or suspected vitamin/trace element deficiencies should be diagnosed and treated.