S YK ZG - Moshe Frenkel, MD

advertisement
(2002 ZCGJYGB) 'K 'CGI ,141 LZM
F B G V Z F
SYKZG\
QJZSG FRGH\ KVSG\ ,FRGH\ KPZGD
,FKZB QC QZT ,NYRZV F[P
FVKI ,KCZTPF NKNDFG FVKI HGIP ,\KNNM \GBKZC K\GZK[ ,QGKRMJF ,JZGVVZ FBGVZN FJNGYVF ,FIV[PF \BGVZN 'IPF ,\K\ZGSPG FPKN[P FBGVZN 'IKF
KM BXPR ,E[F QJZS \GNGIC FERYC TXGC[ ZIB ZYIPC
ZYKTC ,FPKN[PF FBGVZF OGI\C GTKK\SF OK[RFP 62%
,OKRKPJKGG OKNZRKP 49.6%) BVZP KIPXCG OKNZRKPC ,OKRKPJKGGC
.|4~ (YGZK F\ 17.3%-G BVZP KIPX 24.6%
[GN[C OKNVGJP CZYC NBZ[KC FRGZIBN FTXGC[ FZKYSC
OKYGNF OKNVGJPFP 51.2% KM BXPR ,FKDGNGYRGBN \GBVZKP
OGI\P OKRG[ OKTXPBC GTKK\SF GNB \GBVZKPC QJZSF \NIPC
10%-C FBXPR OKRKPJKG-FDP N[ FNKJRFG ,FPKN[PF FBGVZF
.|5~ OKZIB FRGH\ KVSG\ \NKJR FRKGX BN .OKNVGJPFP
Z\GKG Z\GK \NCGYPG FXGVR \MVGF FRGH\ KVSG\ \MKZX
OKZXG\ ,OKNZRKP ,OKRKPJKG OKNNGM FRGH\F KVSG\ .KCZTPF ONGTC
-K\CG \IYZP-K\CN OGKM SRMRF NM .OKZIB OKZK[M\G OKKIPX
.GNB OKZK[M\C OKSGPTF OKVEPFP ONT\FN NGMK GRKB TCJ
OKZMPRF OKRG[ FRGH\ KVSG\ 20,000-P FNTPN OKPKKY C"FZBC
.O[ZKP BNN
GH FRKEPC FRGH\ KVSG\ N[ \GZKMPF GTKDF 1998 \R[C
50%=35% KM BKF FMZTFFG ,ZNGE EZBKNKP 14-M N[ Y\T OGMSN
NBZ[KC .|7,6~ FRGH\ KVSG\ OKMZGX C"FZBC FKKSGNMGBF NNMP
,FRGH\ KVSG\ N[ FMKZXF ZGTK[ NT OKYKGEP OKRG\R GPSZGV BN
QF \IYZPF-K\C \G\[ZP KP[Z BN QVGBC GNCY\F[ \GMZTF LB
ZG[KBC .OKRG[ FRGH\ KVSG\ OKMZGX FKKSGNMGBFP LZTN 20% KM
KVSG\M GB QGHPM OKRKGXP OF \GKG[ZF KEK-NT GNB OKZXGPN Q\KRF
\GRGM\ GNB OKZK[M\N SIKKN Z[VBP GRKB FH ZG[KB ONGB .FRGH\
FRGH\ KVSG\N NGEDF [GYKCF OZGD OKZYPF \KCZPC .KGVKZ N[
OKZXG\N \GKBGVZ \GKZGF \SIKKPF ,\CIZR FNGPT\ \XVFN GNB
KV-NT GIMGF BN GB GYECR BN O\GNKTKG O\GIKJC ,O\GMKB[
OKZXGPFP YNIN OK\TN .|8~ OKZMGPG OKZEDGP OKKBGVZ OKEEP
\KGG\C OKRKGXP ORKB[ OKNKTZ OKZPGI UBG KBGGN-KVSG\ OKVSGP
FRKB \KGG\F KCD-NT \RKGXPF FNGM\F[ GB |10,9~ FNGM\F
\BH OT .|12,11~ NKTVF ZPGIF N[ \YKGEPF FNGM\F \B \VY[P
\GKZIB N[ \PKGSP FEKP OKBZP OKRZXKFP YNI KM ,QKKXN [K
\GMKB \ZYCN OKZXG\F \B KBPXT QVGBC OZKCTFC \KZGCKX
LMC QKB ONGB .(
) \KREVY
.ZXGPF N[ G\GMKBN Z[BC ZG[KB
GMP ± Good Manufacturing Practice
N N MC \C I Z R F M B K F F RG H\ F K V S G\ \M K Z X Z [B M
QJZSF \NIPC OKYGNF OKCZ OKNVGJP[ BNV QKB ,FKKSGNMGBF
GNB FRGH\ KVSG\ \MKZX N[ FVYKFG ,GNB OKTXPBC OD OKZHTR
FKKSGNMGBF NNMC Z[BP Z\GK \CIZR OK\TN BKF QJZS KNGIC
.|7 ,6 ,4=1~
893
N[ CZ ZVSP FNTP FRGH\ KVSG\ N[ \CIZR FM FMKZX
OKKY OBF .QJZS KNGI KEK-NT GNB OKVSG\ \MKZXN TDGRC \GNB[
KVSG\G FRGH\ KPZGD N[ \GIKJCCG \GNKTKC LPG\F YXGP TEKP
OKVSG\ \MKZXN \GTP[P \TEGR OBF ?QJZS KNGIC NGVKJM FRGH\
Z K X Y \
QJ Z SF
K NGIP
\K XIP
, O K KR M E T
O K ZY I P
K B X P KP
KV - N T
OGI\C ZYKTC ,ONGVKJC OKVSGR OKTXPB CN[KPC OKRKRGTP
OKIKM[F OKTXPBF EIB OF FRGH\ KVSG\ .FPKN[PF FBGVZF
NC GY P F
N G V KJ N
FPN[FM
QJ Z SF
K NG I
OK NJ GR
O\ GB [
.FNIPC
GB NVGJPF KEK-NT KBPXT QVGBC OKNJKR GNB OKVSG\
.FPKN[PF FBGVZF OGI\P OKNVJPG OKBVGZ KEK-NT OKTCYR
KCDN
\GCZ
F NK J R F
\GNB[
LZ E
KFPG
F N TP
,GNB
GNB
FRGH\
OKZXG\
N[
KVSG\
\NKJR
O\GIKJCG
O\GNKTK
KVSG\ CN[KP KCDN \GNB[ \GNTGP FH ZPBPC .FPKB\PF
\GKGET
\BCF
LG\
,QJZSF
KNGIC
NGVKJF
OT
GNB
FRGH\
.YGZK F\G OKRDGZJSBGJKV NT \GKRG[BZ \GKTEP
.FH B[GRC KTEP TEKP BKCFN BKF GH FZKYSC FZJPF
G\GTXPBC Q\KR OK\TN ONGB ,ON[GP GRKB FH TEKP ORPGB
ZYKTC ,QJZSF \NIPC OKYGNF OKNVGJPN NM[GP WGTKK \\N
FRGH\ KVSG\ CN[N OK[YCPG FNKTV \GRKKRT\F OKTKCPF GNB
ZV[N NGMK FHM[ NM[GP WGTKK .O\NIPC USGR KNGVKJ KTXPBM
-K\NC FTV[F TGRPNG ,BSKD-EIP G\GNKTKG NGVKJF \GMKB \B
,OKB\P GRKB[ KNGVKJ CN[KP \GCYTC OZDKFN FNGNTF FKGXZ
ZGVK[N SKSC \GGFN NGMK FH WGTKK ,LMP FZ\K .BSKD-LEKBP
.FNGI-BVGZ \ZG[Y\F
QJZSG FRGH\ KVSG\ ,FRGH\ KPZGD
T
KNGIP ZMKR YNI ,OKKRMET OKZYIPC GNCY\F[ OKRG\R KV-N
NGVKJN NKCYPC \GVSGR NGVKJ \GKGZ[VB OK[VIP QJZSF
OKTXPBC \GHMZ\P \GVSGRF NGVKJF \GKGZ[VB .|5=1~ NCGYPF
OKNNGM GNB OKTXPB .'FPKN[P FBGVZ' OTF KVC KGZYF OGI\FP
OKKTEP OKRG\R NT OKSSGCP ORKB O\KCZP[ ,OKRG[ OKNGVKJ QGGDP
KBPXT QVGBC \K[TR GNB NGVKJ KTXPBC \GTKK\SFF .OKYXGP
.OKRG[ OKNVJPG OKBVGZ KEK-NT GB OPXT OKNVGJPF KEK-NT
.GNB OKPKN[P OKNGVKJP ECMR YNI FGGFP FRGH\ KVSG\ \NKJR
QJZSC OKYGNF OKNVGJP GC GNNMRG C"FZBC TXGC[ ZYIPC
) \[MZMF
FRGH\ KVSG\ GNJR 55%-M[ BXPR ,(
TXGPPC OKZK[M\ 2.6 LZX NVGJP NM .OKNZRKPG OKRKPJKG GNNM[
KM ZC\SF ,E[F QJZSC ZCTC GNI[ OK[R N[ FZKYSC .|1~
FZKYSC .|2~ OKRG[ FRGH\ KVSG\ Q\NIP LNFPC GNJR QFP 80.9%
FZKBPP FNIPC GYN[ \GNVGJPFP 56% KM FNT |3~ \ZIB
,FPKN[PF FBGVZF OGI\P OKTXPBC GTKK\SF QKPF-KMZEC
.FRGH\ KVSG\ GMZX 20% OMG\PG
colon cancer
nutritional supplements; dietary supplements; cancer; complementary medicine; alternative medicine; intergrative medicine.
Key words:
(2002 ZCGJYGB) 'K 'CGI ,141 LZM
-\NKEI ZIBN OK[RC OKRDGZJSBGJKVF \GPZ KMZT \YKECC
\GMGPR GNB OKZPGI \GPZ KM ZZC\F ,E[F QJZSC \GYGNF IZGB
ZYIPC .|19~ IZGB-\NKEI ZIBN \GBKZC OK[R \PGTN ZMKR QVGBC
-JSBGJKV N[ FFGCD FMKZX KM ,ODEGF |20~ FKNZJSGBC TXGC[
.E[F QJZSC \GYNN QGMKSF \B K\GTP[P QVGBC F\KIVF OKRDGZ
N[ \GKCZ\ GIYNR OFC[ |21~ OKK\ECTP OKZYIPC ,LMN USGRC
N[ \CMTP FTV[F FPDEGF ,OEB ZGYPP E[ QJZS KB\
.20%=18% N[ ZGTK[C QJZSF KB\ \GCZ\F NT OKRDGZJSBGJKVF
QJZSC OKYGNF OKZCDN Z[YFC OD GBXPR OKPGE OKBXPKP
OKK\BKSB OKZCD KM ,FNT \GKDGNGKPEKVB \GKGETP ;\KRGPZTF
OKZCD \PGTN \KRGPZTF QJZS N[ Z\GK FMGPR \GIKM[C OKYGN
,\GKDGNGKPEKVBF \GKVX\F ECNP ONGB .|22~ CZTPF \GRKEPP
-BGJKV \MKZXC NY QGZ\K ODEGP OKK\GCZT\F OKZYIP ZVSPC
OKNGIC NGVKJN GB \KRGPZTF QJZS N[ TRP \ZJPN OKRDGZJS
\K\GTP[P FEKZK F\VXKR OKZCMT NT OKZYIPC .GH \GZKBPPC
\ZK\T FRGH\C GRGHKR OKZCMTF[M \KRGPZTF QJZS \TVGFC
-JSBGJKV \VSG\ KM ,BXPR |24~ KRKNY ZYIPC .OKRDGZJSBGJKV
QJZS KNGI N[ FXGCYN (Q\[V KTZH) OKRRDKN DGSP OKRDGZ
KB\ N[ \GCZ\FF OGXPKXN FPZD ,IG\KRN FR\PF \TC \KRGPZTF
KB\ N[ (
) \RMG\PF KB\F \GGPF \ZCDFNG QJZSF
.\B[F
apoptosis
[K OKRDGZJSBGJKV \VSG\N[ LMN \GKGET \GPKKY ,FPGEC
.(
) \[MZMF QJZSC OKNGI NT FCKJKP FTV[F
[K OKRGCNVGHKBN FVK[IN KM BXPR ,|25~ FECTPC TXGC[ ZYIPC
GZCT[ KTP \PYKZ N[ N\KVB KB\ \GCZ\F NT \CMTP FTV[F
OKB\C \RMG\P KB\ \GGPN KGZKD OT ,(
) FZP\F
.GNB
colon cancer
transformation
FTV[FN \GKGET \GPKKY ,\G\B[F NT FTV[F ECNP
ONGB .FPGRBNP KNGIC NGVKJM OKRDGZJSBGJKV N[ FCKJKPF
OFN GYZHGF[ |26~ OKZCMTC ZYIPN \GSIKK\PG \GJTGP \GKGETF
OKZCMTC \GZGZDF \GIKM[ KM ,BXPR FH ZYIPC .FPGRBNP KB\
\K\GTP[P FMGPR F\KKF OKRDGZJSBGJKV-\ZK\T FRGH\ GNCKY[
.FZYCF \XGCYC FPDEGF[ GHP
-BGJKV \MKZXC OKMPG\F OKHPZ NT \GTKCXP GNB \GKGET
KRGKR[ TRPCG FKKSGNMGBF NNMC FNIPF N[ KRG[BZ TRPC GNB
?E[F QJZSN OKKNGDS OKRD \GB[GRF OK[RC QGDM ,QGMKS \GXGCYC
,FKDZGZKM) QJZSC EIF NGVKJF CN[C FRGH\ KVSG\ Q\P OBF
FPNIFF KKGMKS \B ZV[N KG[T (FKVZ\GKEZ GB FKDGNGYRGB
KRG[KN[ TRPN Z[YFC FTV[F OKVSG\N \TEGR OBF ?NGVKJFG
OBF ?FNIPF \GR[KFN QGMKSF \RJYF O[N QJZSF \NIP N[
Q G D M , N G V KJ F K T X P B \ G N K T K \ B O K Z V [ P F R G H \ F KV S G \
,LGP\N OGYP [K OBF ?G\GB OKRKJYP GB ,\GRZYFG FKVZ\GPKM
FNTP NVGJPF[M FRGH\ KVSG\ \MKZXP ONT\FN GB EDR\FN
-QKC \GCGD\N OZGD GRKBG NKTZ GRKB[ USG\C NGVKJN \GZ[VB
?\GK\VGZ\
SYKZG\
QFN[ FRCKPC \GPGEF \GCGMZ\ OF GNB OKZPGI . |16 ~
QF ,F[NI \KRDGZJSB \GNKTV GNB \GCGMZ\N .NGKEZJSBN
(Q\[V KTZHC ZYKTC) OKRRDKN \GNNGMG KIPX ZGYPP \GYVGP
.(FKGSC OKBXPR ZYKTC) QKHEKBEG QKJSKRD QGDM ,OKRGCNVGHKBG
QVGBC OKRDGZJSBGJKVC FZK[T FRGH\F \GK\BKSB OK[R CZYC
ONGTC OK[R \PGTN (OGKC OKRGCNVGHKB D"P 200-M) K\GTP[P
D"P 10=5-M) OKRDGZJSBGJKVC EGBP FNE Q\RGH\[ ,KCZTPF
ZGTK[ KM ,ODEGF \GKDGNGKPEKVB \GKVX\C .(OGKC OKRGCNVGHKB
10=4 KV LGPR \GK\BKSB OK[R CZYC OIZFG E[F QJZSP F\GP\F
\GIV QVKC E[F QJZS ,QM-NT-Z\K .|17~ \GKBYKZPB OK[R \PGTN
FNIP N[ Z\GK FMGPR \GIKM[C QKKVB\PG NNM LZEC ZKBPP
.FKNDRBG FYKZPB-QGVXC OK[RN FBGG[FC \GZGZD \IN[PF
FYKZPB-QGVXN \GZDFP \GKRVK OK[R[M KM ,FECGTF \RKKRTP
\MNGFG FNED ,OKRDGZJSBGJKVC FNE FRGH\N Q\RGH\ \B \GR[PG
OK[RC \IGGEPF FPZN FGG\[P BKF[ ET ,E[F QJZS \GIKM[
.|18~ \GKBYKZPBF
F B G V Z F
\GNB[ \KCZPN \GCG[\F ,\KBGVZF \GZVSF \ZKYS LG\P
\GKRKNY \GJNIFN YVSP FRTP \GR\GR QRKBG \GZGZC QRKB GNB
\GECGT NT \MP\SPF FBGVZ N[ KIMGRF QEKTC ZYKTC ,\GSSCGP
)
ZDBPC ,\BHC QKGXPF \GZPN .(
L[PFC GZMHGK) OKKRKNY OKHPZ OKPKKY ZK[TF \KBGVZF \GZVSF
FJNIFC NGYK[ \GGFN OKPKGSP OKZYPC OKKG[T[ ,(ZPBPF
.EKIKF NVGJPF N[ \KRKNYF
evidence based medicine
,\GKTEP \GECGTG OKZYIP NT SSC\FN QGXZF \GZPN ONGB
OD FRGH\ KVSG\ \MKZXN \TEGRF \GTP[PF \B QGICN KGBZ
FJKN[N KTXPB GH FMKZXC OKBGZF OKNVGJPF N[ O\GBZ \EGYRP
-\GMKB \B ZV[N O\RGPBN KG[T[ USGR KTXPBG O\GBKZC NT
.|13~ OFKKI
OKNVGJPFP ZMKR YNI[ FECGTF BGF GH FKDGSC CG[I JCKF
KVSG\ \MKZX NT FJNIFC NVJPF BVGZF \B OKV\[P ORKB
B[GRC JTGP TEKP OKBVGZN KM OKRKPBP O\KCZP .|14,3~ FRGH\
O\KCZP .GNB OKVSG\ \MKZX NT WTKKN OKRKRGTP ORKB[ GB FH
OKRG[F FRGH\F KVSG\ NT Z\GK EGPNN OKBVGZFP OKVXP
FXT \NCYN OFKNB \GRVN GNMGK[ LM ,O\NIPN OKPKB\PF
OKVSGB ,FH FGGYP FNGTV-UG\K[N ET .|13~ FNGTV-UG\K[G
,OKZMPP \GXT :\GZGYP ZVSPP [YGCPF TEKPF \B OKNVGJPF
OKRG\KT ,OKRGIZK ,\KTGXYP FRKB[ \GZVS ,FIV[P-KCGZYG OKRM[
TCJF KZGEPG TCJF \GKGRIC OKZMGP KEK-NT Q\KRF TEKPG ,OKKPGK
.|15~ OKKI-QMSP UBG QPKFP GRKB FH TEKP OK\TN .\IYZPF-K\CC
LM ,ZYGCPF TEKPFG OKRG\RF UGSKBN LZGXF FNGT LM LG\P
KCDN NM[GP WGTKK GN \\NG NVGJPF OT FNGTV U\[N Q\KR[
\GGFN NGMK FHM[ NM[GP WGTKK .ZIB GB FH FRGH\ USG\ \NKJR
TRPC NVGJPF \PXTF LG\ ,FNGI-BVGZ \ZG[Y\F ZGVK[N SKSC
QJY YNI QGICN FSRR FH ZPBP \ZDSPC .QJZSF \NIPC NGVKJG
KR[C EYP\R .FH B[GRC \PKKYF FVRTF \KBGVZF \GZVSF LG\P
O\GB OKMZGXF ,OKNVGJPF KEK-NT CIZR QVGBC OKMZXRF OKVSG\
FBGVZC OKRG[ OKNVJP \XNPF \GCYTC GB KBPXT QVGBC
YZ BNB ,B[GRC TGEKF NM \B UKYFN GR\RGGMC QKB .FPKN[PF
.FKVZDGKNCKCN O\GRVFNG OKBZGYF QKKRT \B ZZGTN
OKRDGZJSBGJKV
Z[YFC ZYKTC ,OKRDGZJSBGJKVC FCZ \GRKKRT\F \PKKY FRGZIBN
\ZMHGP UB \GZGYPFP YNICG ,IZGB-\NKEI NKDC OK[RC NGVKJN
QJZSF \NIP \B TGRPN FZJPC GNB \GCGMZ\ \MKZXN \GSIKK\F
894
(2002 ZCGJYGB) 'K 'CGI ,141 LZM
F B G V Z F
SYKZG\
(CGZKYC) QGHPC OKRDGZJSBGJKV \NGM\
:1
F N C J
D"P 15 { (Y"PS 200 SGM) FKGS CNI
D"P 15 { (FKGS IPY 'D 15) FKGS ZK[M\
D"P 15 { (\KVM) OKRGIJ Q\[V KTZH
D"P 10 { ('D 50) \TNE KRKTZD
D"P 15 { ('D 50) GVGJ
.
.
.
.
OKKDGNGKPEKVB OKZYIPP QF FH F\ NT \GKTEPF \GKGETF ZYKT
.OKKI-KNTC NT OKZYIPPG
F\N[ LM NT \GHPZP OKKDGNGKPEKVBF OKZYIPF \GBXG\
OKZYIP N[ CZ ZVSPCG ,|33~ QJZS-\GEDGR \GRGM\ [K YGZKF
\GYNN QGMKSF \B \KIVP F\F KM BXPR OKKI-KNTCC GTXGC[
IKM[FG ,OKEKBGRGCNV N[ CZ ZVSP KGXP YGZKF F\C .QJZSC
GNB OKZPGI .(
)
-F BGF OFKRKCP
OYNIG ,QJZS-\EDGR \GNKTV OFN OKSIKKPF [KG ,QGXPKI-KEDGR OF
.\KJGKCKJRB \GNKTV KNTCG \YNE-KEDGR OF GNB OKZPGI N[
, E [ F Q J Z S E DR Z Y KT C B K F Q J Z S F \ E DG R \ G N K T VF
\GNIPG FCKYF ,\GBKZF ,ZGTF ,CNCNF ,\[MZMF ,\KRGPZTF
F Z[ P
-F KM BXPR OKZYIP ZVSPC .\GVSGR \GZKBPP
QM-GPM .OKRKY\F OKB\F NT TKV[K[ KNCP ,\RMG\P KB\ \GGP
O\GGF\FN KRGKIF OKHRB { FHBRKYGZGB CMTP FH ZPGI[ BXPR
OKB\ N[ O\GCZ\FN FCG[IF ,SKHRDGKDRB QMG ,QJZS KB\ N[
.|34,29~ OKKRJZS
OKZYGIF OKSIKK\P |35~ FRGZIBN GPSZGV[ OKZYIP KR[C
,K\ECTPF ,QG[BZF ZYIPC .E[F QJZS NT YGZKF F\F \TV[FN
\GIKM[ F\KKF YGZK F\C OKZ[TGP OKP G\[[ OKZCMTC KM BXPR
\K\GTP[P FMGPR QFN[ \GZKBPPF \DZEG QNEGD ,E[F \G\B[
OKZCMTC \G\B[F ,QM-NT-Z\K .ECNC OKP G\[[ OKZCMT \PGTN
GKFG Z\GK ZIGBP CN[C GI\V\F YGZK F\C OKCZGTP OKP G\[[
.QKKVGBC \GPKNB \GIV
GYECR ,QVKC CGZKYC OKR[ Z[T L[PR[ |36~ KRKNY ZYIPC
F\IVF FPDEGF ZYIPC .E[C \B[F \\KZMN IG\KR GZCT[ OK[R
GMZX[ OK[RC IG\KRF ZIBN E[C \GZKBPPF \GR[KF \GIKM[C
F\KKF \B[F \GR[KF ZGTK[ \\IVF .OGKC YGZK F\ \GSGM 3 NTP
.FNIPF N[ K\NI\F CN[C OK[RC YZ \PKKY
,\GZK[K \GKGET QRKB YGZK F\ \MKZXC \GMPG\F \GKGETF
NT TGEK BN[ ZIBP .OKKDGNGKPEKVB OKZYIPP ZYKTC \GTCGRG
J Z V Y G Z K F \ \M K Z X \G C Y T C \ GK \ G T P [P K BG GN - \ GT V [F
F\ \MKZXN \VZGD \GEDR\FC LZGX QKB ,FRK[C \GNY \GTZVFN
.ONGVKJ LNFPC FH KTXPB CN[N OKRKRGTPF OKNVGJP CZYC YGZK
OKNJGRF OKNVGJPC YGZK F\ \MKZXC \GZKFH \[ZER ,\BH OT
,QKEPGY GB QKZKVSB GPM ,F[KZYF QGRDRP NT \GTKV[PF \GVGZ\
NT ZGSBN [K FPGE FCKSP .Q\GNKTV \B ZKCDFN G\KKJR CYT
GB \GKJRD F[KZY \GKTCC OKYGNF OKNVGJPN YGZK F\ \MKZX
WNPGP ,LMP FZ\K .IG\KR ZGCTN OKEPGTF OKNVGJPC QMG ,\G[MZR
BN[ ZIBP ,YGZK F\ \MKZXP TRPKFN \GYKRKP GB \GZF OK[RN
.|29~ FH FY[P N[ G\GIKJC KCDN IGGJ-KMGZB OKZYIP GTXGC
N[ TRPC GB NGVKJC YGZKF F\F CGNK[N OGYP [K QMB OB
YGZK F\ CN[N OGYP [K OB FNB[F FNGT ,OKRG[F QJZSF KDGS
GB FKVZ\GPKMF \GNKTK \B ZV[K FH NGVKJ OBF ?FKVZ\GPKMC
epigallocatechin gallate EGCG
EGCG
895
.
ZGTK[ \\IVFNG \KRGPZTFG E[F QJZS \TKRPN FRGH\C OKRDGZJS
\MKZXC \GZKFHN OKRTGJF [K ONGB .GNB \GNIPP F\GP\F
\GCZ\F NT |27~ OKIGGKE N[ OXPGXP ZVSP CYT ,GNB \GCGMZ\
L[PC Q\RGH\C FKGSF \MKZX \B GNTF[ OK[RC E[F N\KVB KB\
.OKKTGC[
N[ Z[YFC |28 ~ FRGZIBN OSZGV[ FZKYS ZPBPC
\GBXG\ QMG FH K\KKTC B[GR ZMHGP ,E[F QJZSG OKRDGZJSBGJKV
-GE FTV[F [K OKRDGZJSBGJKVN[ LM NT \GTKCXPF OKZYIP
) \KCN[
\GPZC OKR\KRF OKRDGZJSBGJKV .(
QJNGY OGKYC \KR\GPF OKB\ \GCZ\FN OKPZGD \GKDGNGKSKV
NGKEZJSB OT CN[KPC FH QGRKPC OKRDGZJSBGJKV Q\P .QDGZJSB
.OKB\F \GCZ\F N[ NY K\GZI\ CGMKTN OZGD \GKDGNGKSKV \GPZC
\GPZFP LZTN 10 KV) \GKDGNGYPZBV \GPZC ,QM-NT-Z\K
N[ K\GTP[P CGMKTN OKRDGZJSBGJKV OKPZGD (\GKDGNGKSKVF
QM-GPM .QDGZJSBF QJNGY OGKYN Z[Y BNN ,\KB\F \GCZ\FF
QVKSYGPJ N[ CN[KP KM ,|28~ ZPBP G\GBC ZMHGP
K\GZI\ CGMKTN OGZDN KG[T (QKJSKRD ZYKTC) OKRDGZJSBGJKVG
.OKB\F \GCZ\F NT QVKSYGPJF N[ \CMTPF FTV[FF \TKRPNG
OZGD QKJSKRD N[ EGBP OKFGCD OKRGRKP Q\P FH CXPC OD ,\BH OT
.|28~ OKB\ \GCZ\F CGMKT N[ \KJSKDZRKS FTV[FN
biphasic effect
ZYKTC ,OKRDGZJSB \MKZXC \GZKFH \XNPGP ,ZGPBF CYT
\GNJGRF OK[RC GB ,KCGKI QDGZJSB QJNGYG E[F QJZS OT OK[RC
FKGS \MKZXC \GZKFH NT OKXKNPPF [K LMN JZV .QVKSYGPJ
[[I CYT ,IZGB-\NKEIN NKCYPC \GKSKZ\-\\C \GYGNF OK[RC
SKZ\F-\JGNC \GNKTV NT FKGSF KZK[M\ N[ \CMTP FTV[FP
FKGS \MKZXC \GZKFH FR[P JGYRN OKXKNPPF [K ,QM-GPM .|29~
,JNSYGB-OGKXNY DGSP \GKNMC OKRCBC OKYGNF OKNVGJP CZYC
.|30~ GNB OKZXGPC OKJNSYGB N[ FFGCDF FNGM\F CYT
\KCZPC LB ,TGEK GRKB TRGP NGVKJN WNPGPF QGRKPF
(1 FNCJ) OKRGCNVGHKB D"P 100=40 N[ KPGK QGRKP QKGXP \GZGYPF
.|31~
\GKGPM OKNKMPF OKKZISP OKZK[M\ ZVSP YG[C OKPKKY
QZXKF \GMKBC \GBKYC \[ZER .OKRDGZJSBGJKV N[ \GR\[P
OKVSGP OK\TN[ OKVSGR OKCKMZP JGZKVN CN OK[N [KG ,ZK[M\FG
-GG[PF OKRDGZJSBGJKV KZK[M\ C"FZBC GYECR Z[BM .ZK[M\N
BN GYECR[ OKZK[M\F 18 LG\P F[KPI KM BXPR ,C"FZBC OKY
TXGC BN ,QM-GPM .|32~ \KGG\C FRKGX[ FNGM\F \B GNKMF
NMG ,QJZSF \NIPN Z[YFC ZYIP NM GNB OKHMGZP OKZK[M\C
LG\P OKEEGC OKCKMZPN OKSIKK\P ORKB FM ET GRKGX[ OKBXPKPF
\ZK\T FRGH\N BNB ,OKKZISPF OKZK[M\C OKPKKY[ KVM ,GH FRGH\
.OKRDGZJSBGJKV
(camellia
sinensis)
YGZK F\
F\ DGS NT OKRG[F \ZG[Y\F KTXPBC FRGZIBN OKTPG[ JTP BN
F\F BGF FKKSGNMGBF CGZN ZMGPF F\F .YGZKF F\F { '[EI'
G\GBP YVGP YGZKF F\F .ONGTC EGBP WGVR FY[P { ZGI[F
\GNGDS GN \GSIGKP QMNG ,ZGI[F F\FP \GIV ECGTP LB ,IPX
.QVKCG QKSC ZYKTC \GZGE FHP WGVR YGZKF F\F .Z\GK \GYHI KGVKZ
(2002 ZCGJYGB) 'K 'CGI ,141 LZM
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
ECNC OKZGVS OKZYIP \GRGZIBF OKR[C GTXGC KM ZC\SP ?LVFN
OKZYIPP EIBC .QVKC OKZYGI \XGCY KEK-NT ONGM ,FH B[GRC
F\F KCKMZP N[ CN[KP KM BXPR ,OKZCMTC TXGC[ |37~ GNB
\B ZVK[ ,FNI[F N[ FPGZYBSC NGVKJM QKXKPBKZEB OT YGZKF
QKXKCGZGSYGE N[ HGMKZ BXPR BSKD-EIP .FKVZ\GPKMF \GNKTK
HGMKZC FEKZK FNI BSKD-LEKBPG ,\B[ KB\C 2.7 KV FGCDF
.|37~ \GBKZCF \GPYZC QKXKCGZGSYGE
N[ FGCD HGMKZ ODEGF OKZCMTC TXGC[ FPGE ZYIPC
\B[F-\EDGR \GNKTVF ZGVK[ OT FKPYKN KB\C QKXKCGZGSYGE
.|38~ YGZKF F\F KCKMZP OT CN[KPC Q\KR NGVKJF[M
LB ,FC[IPN \GEGYR OKNTP GNB OKJTGP OKZYIP KBXPKP
GH FCKSP .OEB-KRCC OKKRKNY OKZYIP FH OGI\C GTXGC BN FM ET
GNB \GKVX\ [[BN \RP NT ;\GVZGD \GXNPF TGCYN Q\KR BN
.OKZYGCP OKKRKNY OKZYIP OK[ZER
SYKZG\
10.
therapeutic substances of traditional Chinese medicines in
Taiwan. J Clin Pharmacol, 1997; 37: 334-350.
Slifman NR, Obermeyer WR, Aloi BK & al, Contamination of
botanical dietary supplements by Digitalis Lanata. N Engl J
Med, 1998; 339: 806-811.
Gurley BJ, Gardner ST & Hubbord MA, Content versus label
claims in ephedra-containing dietary supplements. An J Health
Syst Pharm, 2000; 57: 1-7.
ConsumerLab.Com, LLC. Available at http: //www.consumerlab.com.
Eliason BC, Huebner J & Marchand L, What physicians can
learn from consumers of dietary supplements. J Fam Pract,
1999; 48: 459-463.
Eliason BC, Myzkowski J, Marbella A & al, Use of dietary
supplements by patients in a family practice clinic. J Am Board
Fam Pract, 1996; 9: 249-253.
Gotay CC & Dumitriu D, Health food store recommendations
for breast cancer patients. Arch Fam Med, 2000; 9: 692-698.
Frenkel M, Non-hormonal treatment alternatives during menopause and beyond. Harefuah, 1999; 136: 144-148.
Burke GL, Vitolins MZ, Bland D & al, Soybean isoflavones as an
alternative to traditional hormone replacementtherapy: are we
there yet? J Nutr, 2000; 130: 664S-665S.
Murkies AL, Wilcox G & Davis SR, Clinical Review 92:
Phytoestrogens. J Clin Endocrinol Metab, 1998; 83: 297-303.
Murkies A, Dalais FS, Briganti EM & al, Phytoestrogens and
breast cancer in postmenopausal women: a case control study.
Menopause, 2000; 7: 289-296.
Murkies A, Dalais FS, Briganti EM & al, Phytoestrogens and
breast cancer in postmenopausal women: a case control study.
Menopause, 2000; 7: 289-296.
Ingram D, Sanders K, Kolybaba M & al, Case-control study of
phytoestrogens and breast cancer. Lancet, 1997; 350: 990-994.
Hirano T, Fukuoka K, Oka K & al, Antiproliferative activity of
mammalian lignan derivatives against the human breast
carcinoma cell line, ZR-75-1.
Denis L, Morton MS & Griffiths K, Diet and its preventive role
in prostatic disease. Eur Urol, 1999; 35: 377-387.
Pollard M & Wolter W, Prevention of spontaneous prostaterelated cancer in Lobund- Wistar rats by a soy protein isolate/
isoflavone diet. Prostate, 2000; 45: 101-105.
Demark-Wahnefried W & Price DT, Pilot study of dietary fat
restriction and flaxseed supplementation in men with prostate
cancer before surgery: exploring the effects on hormonal levels,
prostate specific antigen, and histopathologic features. Urology,
2001; 58: 47-52.
Yan L, Yee JA, Li D & al, Dietary flaxseed supplementation and
experimental metastasis of melanoma cells in mice. Cancer
(Letter), 1998; 124: 181-186.
McMichael-Phillips DF, Harding C, Morton M & al, Effects of
soy-protein supplementation on epithelial proliferation in the
histologically normal human breast. Am J Clin Nutr, 1998;
68(suppl): 1431S-1436S.
Booth C, Hargreaves DF, Hadfield JA & al, Isoflavones inhibit
intestinal epithelial cell proliferation and induce apoptosis in
vitro. Br J Cancer, 1999; 80: 1550-1557.
F B G V Z F
F[KZE \GCYTC LNGFG CIZ\P FRGH\F KVSG\ YG[ ,OGMKSN
ZCTP UB ,JZVC QJZSF KNGI ZGCKXCG NNMC \CIZR \KZGCKX
\GCZ \GNB[C FGGNP GH FMKZX .FKKSGNMGBF NNMC F[KZEN
OKZXGP N[ YGGK[FG ,KTP[P-EI GB ZGZC EKP\ GRKB QFN FRTPF[
.ZEGSP KZGCKX IGYKVG \KREVY \GMKB-\ZYC BNN NFR\P GNB
LM ,ZYGCPF TEKPFG OKRG\RF UGSKBN LZGXF FNGT ,LEKBP
NM[GP QVGBC GN WTKKNG NVGJPF OT FNGTV U\[N FKFK Q\KR[
\GGFN NGMK FHM[ NM[GP WGTKK .QKKRGTP BGF GC[ USG\ \MKZX NT
NVGJPF \PXTF LG\ ,FNGI-BVGZ \ZG[Y\F ZGVK[N SKSC
.GH FNIPC OKNGIC NGVKJCG QJZSF \NIP \TKRPC
F K V Z D G K N C K C
1. Sandler SR, Halabi S, Kaplan EB & al, Use of vitamins,
minerals, and nutritional supplements by participants in a
chemoprevention trial. Cancer, 2001; 91: 1040-1045.
2. Newman V, Rock CL, Faerber S & al, Dietary supplement use by
women at risk for breast cancer recurrence. The Womens'
Healthy Eating and Living Study Group. J Am Diet Assoc,
1998; 98: 285-292.
3. Von Gruenigen VE, White LJ, Kirven MS & al, A comparison of
complementary and alternative medicine use by gynecology and
gynecologic oncology patients. Int J Gynecol Cancer, 2001; 11:
205-209.
4. Boon H, Stewart M, Kennard MA & al, Use of complementary/
alternative medicine by breast cancer survivors in Ontario:
prevalence and perceptions. J Clin Oncol, 2000; 18: 2515-2521.
5. Paltiel O, Avitzour T, Cherny N & al, Determinants of the use of
complementary therapies by patients with cancer. J Clin Oncol,
2001; 19: 2439-2444.
6. Go VLW, Wong DA, Resnick MS & Heber D, Evaluation of
botanicals and dietary supplements therapy in cancer patients. J
Nutr, 2001; 131: 179S-180S.
7. Ervin RB, Wright JD & Kennedy-Stephenson J, Use of dietary
supplements in the United States, 1988-1994. Vital Health Stat,
1999; 11: 1-14.
8. Lavy T, Haran B, Shemer J & Shani S, Regulation of natural
medicines in Israel and abroad. Harefuah, 2000; 139: 339-344.
9. Huang WF, Wen KC & Hsiao ML, Adulteration by synthetic
896
(2002 ZCGJYGB) 'K 'CGI ,141 LZM
F B G V Z F
SYKZG\
29. This P, De la Rochefordiere A, Clough K & al, Phytoestrogens
after breast cancer. Endocrine-Related Cancer, 2001; 8: 129-134.
30. PDR for Nutritional Supplements. Montavale, NJ: Medical
Economics; 2001.
31. Massey LK, Palmer RG & Horner HT, Oxalate content of
soybean seeds, soyfoods, and other edible legumes. J Agric Food
Chem, 2001; 49: 4262-4266.
32. Ernst E, The Desktop Guide to Complementary and Alternative
Medicine. St. Louis: Mosby; 2001.
33. http: //www.consumerlab.com/results/phytoestrogens2.asp
34. Bushman JL, Green tea and cancer in humans: a review of the
literature. Nutr Cancer, 1998; 31: 151-159.
35. Mukhtar H & Ahmad N, Green tea in chemoprevention of
cancer. Toxicol Sci, 1999; 52(2 Suppl): 111-117.
36. Kavangh KT, Hafer LJ, Kim DW & al, Green tea extracts
decrease carcinogen-induced mammary tumor burden in rats
and rate of breast cancer cell proliferation in culture. J Cell
Bioch, 2001; 82: 387-398.
37. Inoue M, Tajima K, Mizutani M & al, Regular consumption of
green tea and the risk of breast cancer recurrence: follow-up
study from the Hospital-based Epidemiologic Research Program
at Aichi Cancer Center (HERPACC), Japan. Cancer Lett, 2001;
167: 175-182.
38. Sugiyama T & Sadzuka Y, Enhancing effects of green tea
components on the antitumor activity of adriamycin against
M5076 ovarian sarcoma. Cancer Lett, 1998; 133: 19-26.
39. Sadzuka Y, Sugiyama T & Sonobe T, Efficacies of tea
components on doxorubicin induced antitumor activity and
reversal of multidrug resistance. Toxicol Lett, 2000; 114: 155162.
FYKRGZM
FYKJKNGVF NXC FBGVZ
\G[DZG OKYKGEP ORKB[ OKZGBK\ .QDGF QGKEN I\V ZK\GP
-GZV FNGPT\N I\V FGGFP ZCEFG ,\GECGT QG[NM OKBCGP
.\KCZT
\B ZBK\[M N"FX N[ G\GKZSGP \B Z[NC FNTF QM-GPM
.[VRC ZYK ZKIP F\CD UB[ ,QKR'DC BCXF N[ G\NGTV
QKCN OKECB\P OKNCIP N[ KBRKJSNVF ZGZJF QKC FBGG[FF
.\TEF NT \NCY\P FRKBG FEKZIP ,N"FX NKTVP[ "ZGZJF"
NGP OKTGDKV NGYKSN N"FX \GRRGD\F B[GR \B FNTF Z[NC
\GNGTV ZGBK\ .T[VP FVI FKKSGNMGB CZYC OKNCIP \GECB\F
N"FX \KPE\C TDGVG QPKFP GRKB \GZJPFG TYZF BNN N"FX
.KZSGP BCXM
FRKICP TZP OZGD GRKB N"FX[ ECNC GH BN KM QKKX Z[NC
TGKS YVSPF KRG[BZF OZGDF UB BGF OK\TN[ BNB ,\KBGVZ
,QKKXN Z\GPN ,OKRKJSNVF .OGBN NECF BNN IJ[C KBGVZ
SRNGCPB \GEKKR LG\C WVR-KZPGI OKRKPJP BYGGE GBXPR
.OKTGXV GRKV FZGBMN[
897
FRPBRC DXKKPF KJKNGV-KB UGDM K"ZF \B DKXF Z[NC
\GZPN KM QKKXN Z\GPN .(OKCZTG OKEGFK) OKNBZ[K OKBVGZ
OKRGKENG \GKGIXR\FN OGYPF FH QKB KM Z[NC QTGJ ,FCGD\F
K\GMKB \GKFN ZPKK\PF KBGVZ-KTEP \T-C\M KCD-NT OKKJKNGV
.KJKNGV-KBG
P" G
Lancet
-KCZTF LGSMSN QGKNKD
\TF-C\M [KEYF ,DKZI QVGBC
) KNBZ[K
FKF FH QGKNKDC OKZPBPFP EIB .(
OKENK CZYC \GK[DZ \GKTC GZYI Z[B ,'CIG
N[
ZYIPF \XGCYC ECNC OKENK 91 GZYSR FH ZYIPC .OKRKJSNV
BN OFK\C[ FZYCF \XGCYC OKENK 89-G ,GHDVGF OFK\C[
FRKICP ZYIPC OKNNMRF ZIB GCYT OKZYGIF .GTDVR
OKNGNT FPINP KZGHBC OKENK KM ,FNT OZYIPP .\KZJBKMKSV
NNM-LZEC[ \GZIB \GK[DZ \GKTCCG FEZI \GTZVFC \GYNN
.\GRICGBP QRKB
\G K T C N \G T E GP F \ B \ GN T FN O K X K NP P OK Z C I PF
.\KJKNGV \GPKNBN GV[IR[ OKENKC OKNVJP Z[BM NGVKJNG
.KBRK\[NVF EXF { TDVRM SZ\PF N[ EIB EX DXGP ZPBPC
\ G KD G S C Y S T \ T F - C \ M [ F R G [ B Z F O T V F G H Q K B
BN[ ,\KEEX-EI BKF \VY\[PF FEPTF \IB BNG ,\GKJKNGV
\TF-C\M N[ GYGSKTN \KNBZ[K FCGD\ .\KCZT-GZV ZPGN
\GZE\SFF Z"GK ,Z[NC OZGK KEK-NT FR\KR OKKJKNGV OKB[GRC
KJKNGV ZPBPN CKDF[ ,(
) \KBGVZF
.2002 NKZVBC OSZGV[
-C\M N[ YGSKTF OXTP TGHTHF \B Z[NC TKCF \K[BZ
NT OTH TKCP Z[NC .OKKJKNGV OKB[GRC FH K\ZYGK KBGVZ \T
YGSKT OGYPC ,KNBZ[K-KJRBFG KEEX-EIF KJKNGVF ZGBK\F
ISGR .LGSMSF \B \GGNPF \GBKZCF \GKTCC KTEPG K\KPB
GRKBG ,\GKJKNGVF \GNB[CG OKZGBK\C YVS NKJP GRKB OKZPBPF
Lancet, 2002;359
Thabet
Lancet, 2002;359:185-189
Download