原发性肝癌经导管肝动脉化疗栓塞术后应用不同保肝方案的效果比较研究

发布时间：2018-08-11 17:15

【摘要】：目的探讨原发性肝癌(PLC)经导管肝动脉化疗栓塞(TACE)术后应用不同保肝方案的保肝效果,为临床保肝治疗提供理论依据。方法选取2013年10月—2016年10月河北医科大学第四医院收治的PLC患者180例,根据静脉滴注类保肝药物分类及保肝药物联合应用原则采用完全随机化分组分为6组(A、B、C、D、E、F组),每组30例。TACE术后给予两药联合保肝治疗,A组给予肝细胞膜修复保护剂+解毒类(多烯磷脂酰胆碱+还原型谷胱甘肽)、B组给予肝细胞膜修复保护剂+抗炎类(多烯磷脂酰胆碱+异甘草酸镁注射液)、C组给予肝细胞膜修复保护剂+利胆类(多烯磷脂酰胆碱+丁二磺酸腺苷蛋氨酸)、D组给予解毒类+抗炎类(还原型谷胱甘肽+异甘草酸镁注射液)、E组给予解毒类+利胆类(还原型谷胱甘肽+丁二磺酸腺苷蛋氨酸)、F组给予抗炎类+利胆类(异甘草酸镁注射液+丁二磺酸腺苷蛋氨酸)。记录并比较6组患者TACE术前3 d及术后第1天、第4天、第6天肝功能[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBIL)、直接胆红素(DBIL)]水平,观察TACE相关并发症及药物不良反应。结果不同保肝方案与时间在ALT、AST、TBIL、DBIL水平上存在交互作用(P0.05),保肝方案、时间对ALT、AST、TBIL、DBIL水平的主效应显著(P0.05)。6组患者术后第1天、第4天、第6天时ALT、AST、TBIL、DBIL水平较术前3 d时升高(P0.05)。术前3 d和术后第1天时,6组患者ALT、AST、TBIL、DBIL水平比较,差异均无统计学意义(P0.05)。术后第4天时,6组患者ALT、AST、TBIL、DBIL水平比较,差异有统计学意义(P0.05);其中B、D、F组低于A、C、E组,F组低于B、D组(P0.05)。术后第6天时,6组患者ALT、AST、TBIL、DBIL水平比较,差异有统计学意义(P0.05);其中B、D、F组低于A、C、E组,F组低于B、D组,C组低于A、E组(P0.05)。6组患者在治疗过程中主要不良反应为消化系统反应(表现为恶心、呕吐及食欲下降等)、轻度骨髓抑制、栓塞后综合征(表现为发热、肝区不适或肝区疼痛等),经对症处理后缓解,均未发生过敏、心悸、皮疹等药物不良反应。结论急性肝损伤是TACE术后无法避免的并发症,抗炎类保肝药为首选药物,联合利胆类效果最佳,能有效改善患者肝功能,降低PLC介入治疗风险,值得临床推广使用。
[Abstract]:Objective to investigate the effect of different liver protection schemes after transcatheter hepatic arterial chemoembolization (TACE) for primary liver cancer (HCC), and to provide theoretical basis for clinical hepatoprotective therapy. Methods 180 patients with PLC were selected from October 2013 to October 2016 in the fourth Hospital of Hebei Medical University. According to the classification of intravenous infusion of hepatoprotective drugs and the principle of combined application of hepatoprotective drugs, totally randomized groups were divided into 6 groups (group A). 30 cases in each group were treated with two drugs combined with hepatoprotective therapy after TACE. Group A was given liver cell membrane repair protection agent. Detoxification group (polyenylphosphatidylcholine reduced glutathione) group B was given liver cell membrane repair protection agent anti-inflammatory (polyenylphosphatidylcholine isoglycyrrhizinate magnesium injection) and group C was given liver cell membrane repair protection agent choledochal. Group D was given antiinflammatory drugs (reduced glutathione isoglycyrrhizic acid magnesium injection) and group E was given detoxification and gallbladder (reduced glutathione butadienesulfonate). Group F was treated with anti-inflammatory choledochus (magnesium isoglycyrrhizinate injection) and adenosylmethionine disulfonate. Liver function [alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (DBIL)] was recorded and compared 3 days before TACE and 1, 4 and 6 days after TACE in 6 groups. TACE related complications and adverse drug reactions were observed. Results there were significant effects of different liver protection regimen and time on the level of alt ASTT TBILL DBIL (P0.05). The main effect of liver protection regimen and time on the level of alt ASTT TBILN DBIL was significant (P0.05). The level of alt ASTTBILN DBIL increased on the 1st, 4th and 6th day after operation (P0.05). There was no significant difference in the levels of alt ASTIL and TBIL-DBIL between the 6 groups on the 3rd day before operation and the first day after operation (P0.05). On the 4th day after operation, there was a significant difference in the level of alt ASTT TBILN DBIL between the 6 groups (P0.05), and the level of DBIL was lower in the BDU F group than that in the BND D group (P 0.05). On the 6th day after operation, there was a significant difference in the level of alt ASTT TBILN DBIL between the six groups (P0.05), in which the main adverse reactions in the treatment process were digestive system reactions (nausea, nausea), the main adverse reactions of the patients in group B, D, F, C, C and C, were lower than those in group C, which were lower than those in group C (P0.05), and in the course of treatment, the main adverse reactions were digestive system reactions (nausea, nausea). Vomiting and loss of appetite), mild bone marrow suppression, post-embolism syndrome (manifested as fever, liver area discomfort or liver area pain, etc.), after symptomatic treatment, there were no adverse drug reactions, such as allergy, palpitations, rashes and so on. Conclusion Acute liver injury is an unavoidable complication after TACE. Anti-inflammatory drugs are the first choice and combined with choledochism is the best. It can effectively improve the liver function of patients and reduce the risk of interventional therapy of PLC. It is worthy of clinical application.
【作者单位】：河北医科大学第四医院放射科;
【基金】：河北省医学科学研究重点课题项目(20160181)
【分类号】：R735.7

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