晚期非小细胞肺癌患者化疗后肝损伤164例临床分析被引量：19

Clinical analysis of liver injury in 164 patients with advanced non-small cell lung cancer after chemotherapy

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摘要目的探讨晚期非小细胞肺癌（NSCLC）患者接受化疗后肝功能指标的变化及其临床意义。方法回顾性分析2007年1月至2010年9月病史资料完整的NSCLC患者164例，所有患者均接受多西他赛或者吉西他滨联合奈达铂的方案全身化疗，定期监测患者肝功能指标，并行肝脏彩色超声检查了解患者肝脏的形态学变化情况。结果患者行多西他赛或者吉西他滨联合奈达铂化疗前丙氨酸氨基转移酶（ALT）、天冬氨酸氨基转移酶（AST）中位水平分别为29、30U／L，治疗后分别升高至54、39U／L，治疗前后差异均有统计学意义（P〈0．05），化疗前后γ-谷氨酰氨基转移酶（γ-GT）、碱性磷酸酶（ALP）、总胆红素（TBL）水平变化差异无统计学意义（均P〉0．05）。氨基转移酶的异常升高与患者性别、年龄、肿瘤病理类型、临床分期无关（P〉0．05）；吉西他滨化疗组患者较多西他赛化疗组患者易出现氨基转移酶的异常升高（P〈0．05）；化疗前合并肝转移的患者及乙型肝炎表面抗原（HBsAg）阳性的患者易出现氨基转移酶的异常升高（P〈0．05）。结论晚期NSCLC患者行多西他赛或者吉西他滨联合奈达铂化疗可引起氨基转移酶的异常升高，化疗前合并肝转移、HBsAg阳性及化疗过程中使用吉西他滨可能是肝损害的危险因素。 Objective To analyze the changes and clinical significance of live function in advanced non-small cell lung cancer after chemotherapy. Methods The data of 164 patients histopathologically confirmed as advanced nonsmall cell lung cancer with complete medical history data from January 2007 to September 2010 were retrospectively analyzed. All the patients received chemotherapy by docetaxel or gemcitabine plus nedaplatin, regular liver function hematological monitoring and liver color ultrasound examination, which revealed the changes of liver function and liver morphology. Results Docetaxel or gemcitabine plus nedaplatin could induce liver function indexes abnormality in patients with advanced nonsmall cell lung cancer. The main symptoms were the rise of ALT, AST with different extent （ALT： 29 U/L vs 30 U/L, AST： 54 U/L vs 39 U/L, P 〈 0.05）, which were not related with the sex, age, tumor pathologic types and the clinical stages （P 〉 0.05）. Patients received chemotherapy by gemcitabine were inclined to experience liver function indexes abnormality （P 〈 0.05）. Patients with hepatic metastases and hepatitis B surface antigen positive before chemotherapy were inclined to experience liver function indexes abnormality （P 〈 0.05）. The ALP, γ-GT, TBL, ALB levels after treatment were almost the same as those before treatment （P 〉 0.05）. Conclusions Taking docetaxel or gemcitabine plus nedaplatin could induce liver function indexes abnormality in patients with advanced nonsmall cell lung cancer. Patients treated by chemotherapy complicated with hepatic metastases, hepatitis B surface antigen positive and treatment by gemcitabine were inclined to experience liver function indexes abnormality, which is value to research.