化疗所致味觉改变(CITA)是肿瘤治疗中常见却易被忽视的不良反应。这种味觉感知的改变或丧失不仅直接影响患者的进食体验,更通过“味觉改变-食欲下降-营养摄入不足-体重减轻-免疫功能受损”的连锁反应,严重影响患者的营养状况、治疗耐受性及生存质量。CITA发生率较高,其发生并非单一因素所致,而是治疗相关因素(化疗药物、化疗周期)、患者自身特征(性别、年龄)、伴随症状(口腔黏膜炎、口干、恶心等)及社会心理因素(缺乏社会支持、焦虑)共同作用的结果。锌作为人体必需的微量元素,在味蕾细胞更新、信号传导与修复中发挥关键作用,锌能否改善CITA引起了研究者的广泛关注。本文系统梳理了CITA的流行病学现状、锌在味觉生理中的作用、化疗导致锌缺乏及味觉损伤的病理机制,并结合近年锌剂干预CITA的临床研究证据,基于现有证据展望未来研究方向,以期为CITA的评估与治疗提供科学依据。
Abstract
Chemotherapy-induced taste alteration (CITA) is one of the most common but often ignored side effects in cancer treatment. The change or loss of taste perception not only directly affects the patients' eating experience, but also seriously damages the patients' nutritional status and treatment through the chain reaction of "dysgeusia-decreased appetite-insufficient nutritional intake-weight loss-impaired immune function, tolerance, and quality of life". The incidence of CITA is high. CITA is not determined by one single factor, but is the result of the combined effects of treatment-related factors (chemotherapy drugs, chemotherapy cycles), patients' own characteristics (gender, age), concomitant symptoms (oral mucositis, dry mouth, nausea, etc.) and psychosocial factors (lack of social support, anxiety). As an essential trace element for the human body, zinc plays an irreplaceable role in the renewal, signal transduction, and repair of taste buds cells, while whether zinc supplements have a certain effect on CITA has attracted widespread attention from researchers. This review systematically summarizes the epidemiological status of CITA, the core role of zinc in taste physiology, the pathological mechanisms of zinc deficiency and taste damage caused by chemotherapy. It also comprehensively analyzes the evidence of clinical research on zinc intervention in CITA in recent years, looking forward to focusing on research directions and providing scientific basis for evaluation and treatment of CITA.
关键词
肿瘤 /
化疗所致味觉改变 /
流行现状 /
影响因素 /
锌缺乏 /
锌剂 /
营养干预 /
综述
Key words
Cancer /
Chemotherapy-induced taste alteration /
Epidemic status /
Risk factors /
Influencing factors /
Zinc insufficiency /
Zinc supplement /
Nutritional intervention /
Review
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参考文献
[1] 李琪, 赖泽鹏, 蒋炬希, 等. 中美恶性肿瘤的流行现状及趋势比较[J]. 中国普外基础与临床杂志, 2025,32(6):702-713.
[2] HOVAN A J, WILLIAMS P M, STEVENSON-MOORE P, et al. A systematic review of dysgeusia induced by cancer therapies[J]. Support Care Cancer, 2010,18(8):1081-1087.
[3] 张婷婷,张丽燕. 肿瘤患者化疗相关性味觉改变干预的研究进展[J]. 护理学杂志, 2020,35(12):99-102.
[4] DRARENI K, DOUGKAS A, GIBOREAU A, et al. Relationship between food behavior and taste and smell alterations in cancer patients undergoing chemotherapy: a structured review[J]. Semin Oncol, 2019,46(2):160-172.
[5] ZHANG B, ZHANG N, ZHANG Y, et al. Prevalence and risk factors of chemotherapy-induced taste alterations among cancer patients: a systematic review and meta-analysis[J]. Eur J Oncol Nurs, 2025,74:102735.
[6] 力晶, 毛秋婷, 黄毅, 等. 癌症化疗患者味觉改变发生率及影响因素的meta分析[J]. 中华护理杂志, 2025,60(14):1778-1785.
[7] STEINBACH S, HUMMEL T, B?HNER C, et al. Qualitative and quantitative assessment of taste and smell changes in patients undergoing chemotherapy for breast cancer or gynecologic malignancies[J]. J Clin Oncol, 2009,27(11):1899-1905.
[8] MCANENA O J, DALY J M. The impact of antitumor therapy on nutrition[J]. Cancer, 1985,55(1):273-278.
[9] 孙晓文,张文莹,王锦航. 化学治疗味觉改变评价量表的汉化及其在乳腺癌患者应用中的信效度[J]. 临床与病理杂志, 2018,38(1):125-130.
[10] ZABERNIGG A, GAMPER E M, GIESINGER J M, et al. Taste alterations in cancer patients receiving chemotherapy: a neglected side effect?[J]. Oncologist, 2010,15(8):913-920.
[11] CHUNG J H, PHALKE N, HASTINGS C, et al. Zinc deficiency and its association with treatment-related toxicity in children with cancer[J]. Pediatr Blood Cancer, 2021,68(9):e29104.
[12] KOIZUMI T, FUKUSHIMA T, TATAI T, et al. Successful treatment of crizotinib-induced dysgeusia by switching to alectinib in alk-positive non-small cell lung cancer[J]. Lung Cancer, 2015,88(1):112-113.
[13] SEIKI Y, IKEZAWA K, KAI Y, et al. Impact of zinc deficiency on the prognosis of unresectable pancreatic cancer[J]. Pancreatology, 2025,25(4):552-557.
[14] KISS N, SYMONS K, HEWITT J, et al. Taste function in adults undergoing cancer radiotherapy or chemotherapy, and implications for nutrition management: a systematic review[J]. J Acad Nutr Diet, 2021,121(2):278-304.
[15] MALTA C E N, DE LIMA MARTINS J O, CARLOS A C A M, et al. Risk factors for dysgeusia during chemotherapy for solid tumors: a retrospective cross-sectional study[J]. Support Care Cancer, 2022,30(1):313-325.
[16] 黄文霞,柏倩雯, 钱静,等. 肺癌化疗患者味觉改变与其营养状况及癌因性疲乏的相关性研究[J/CD]. 肿瘤代谢与营养电子杂志, 2024,11(4):566-570.
[17] 张婷婷, 张丽燕. 肿瘤患者化疗相关性味觉改变干预的研究进展[J]. 护理学杂志, 2020,35(12):99-101.
[18] ERKURT E, ERKISI M, TUNALI C. Supportive treatment in weight-losing cancer patients due to the additive adverse effects of radiation treatment and/or chemotherapy[J]. J Exp Clin Cancer Res, 2000,19(4):431-439.
[19] BÜNTZEL J, GLATZEL M, MÜCKE R, et al. Influence of amifostine on late radiation-toxicity in head and neck cancer--a follow-up study[J]. Anticancer Res, 2007,27(4a):1953-1956.
[20] LESSER G J, IRBY M B, TAYLOR R C, et al. Lactoferrin supplementation for taste and smell abnormalities among patients receiving cancer chemotherapy[J]. Support Care Cancer, 2022,30(3):2017-2025.
[21] BÜNTZEL J, RIESENBECK D, GLATZEL M, et al. Limited effects of selenium substitution in the prevention of radiation-associated toxicities. Results of a randomized study in head and neck cancer patients[J]. Anticancer Res, 2010,30(5):1829-1832.
[22] HOPPE C, KUTSCHAN S, DÖRFLER J, et al. Zinc as a complementary treatment for cancer patients: a systematic review[J]. Clin Exp Med, 2021,21(2):297-313.
[23] WILKEN M K, SATIROFF B A. Pilot study of "miracle fruit" to improve food palatability for patients receiving chemotherapy[J]. Clin J Oncol Nurs, 2012,16(5):E173-E177.
[24] HENKIN R I, BRADLEY D F. Hypogeusia corrected by ni++ and zn++[J]. Life Sci II, 1970,9(12):701-709.
[25] HAMANO H, YOSHINAGA K, TANAKA T, et al. Polaprezinc, a zinc compound, is distributed to the lingual epithelium and increases its zinc concentration in zinc-deficient rats[J]. Life Sci, 2009,85(21-22):759-764.
[26] HALYARD M Y, JATOI A, SLOAN J A, et al. Does zinc sulfate prevent therapy-induced taste alterations in head and neck cancer patients? Results of phase iii double-blind, placebo-controlled trial from the north central cancer treatment group (n01c4)[J]. Int J Radiat Oncol Biol Phys, 2007,67(5):1318-1322.
[27] LI P, XU J, SHI Y, YE Y, et al. Association between zinc intake and risk of digestive tract cancers: a systematic review and meta-analysis[J]. Clin Nutr, 2014,33(3):415-420.
[28] ITO K, YUKI S, NAKATSUMI H, et al. Multicenter, prospective, observational study of chemotherapy-induced dysgeusia in gastrointestinal cancer[J]. Support Care Cancer, 2022,30(6):5351-5359.
[29] 李宜珈, 杨暄, 许文涛. 锌对细胞损伤的保护机制研究进展[J]. 食品与营养科学, 2014,3(4):57-63.
[30] ISEKI M, MIZUMA M, SHIMURA M, et al. Preoperative chemotherapy with gemcitabine for pancreatic cancer causes zinc deficiency[J]. Pancreas, 2025,54(2):e75-e81.
[31] YAMAGATA T, NAKAMURA Y, YAMAGATA Y, et al. The pilot trial of the prevention of the increase in electrical taste thresholds by zinc containing fluid infusion during chemotherapy to treat primary lung cancer[J]. J Exp Clin Cancer Res, 2003,22(4):557-563.
[32] NISHIJIMA S, YANASE T, TSUNEKI I, et al. Examination of the taste disorder associated with gynecological cancer chemotherapy[J]. Gynecol Oncol, 2013,131(3):674-678.
[33] MAZZOLENI B, FERRARI G, CACCIALANZA R, et al. Pharmacological strategies and nutritional supplements for managing dysgeusia among chemotherapy patients: a systematic review[J]. Clin Nutr ESPEN, 2024,63(2):20-30.
[34] KIM M J, TANG M J, BRUERA E. Prolonged zinc use for dysgeusia causing copper deficiency[J]. Palliat Support Care, 2026,24:e37.
[35] SEIKI Y, IKEZAWA K, WATSUJI K, et al. Zinc supplementation for dysgeusia in patients with unresectable pancreatic cancer[J]. Int J Clin Oncol, 2024,29(8):1173-1181.
[36] YANAZUME S, USHIWAKA T, YOROUKI H, et al. Zinc supplementation during chemotherapy for gynecological malignancy[J]. J Obstet Gynaecol Res, 2021,47(11):3998-4004.
[37] FUJII H, HIROSE C, ISHIHARA M, et al. Improvement of dysgeusia by polaprezinc, a zinc-l-carnosine, in outpatients receiving cancer chemotherapy[J]. Anticancer Res, 2018,38(11):6367-6373.
基金
中国营养学会科研基金—西安力邦临床营养专项基金(CNS-LIBANG2025-44)
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