淋巴瘤化疗诱发肝衰竭患者临床特点与预后分析

目的 总结因淋巴瘤化疗后发生肝衰竭患者的病历资料,分析其发生肝衰竭的原因和影响结局的因素,以提高临床诊治能力。方法 采用回顾性分析法总结21例接受化疗的淋巴瘤患者在发生肝衰竭后的临床特点治疗经过和预后变化。结果 在21例患者中,非霍奇金淋巴瘤20例,霍奇金淋巴瘤1例;接受利妥昔单抗和化疗药物化疗;诱发肝衰竭的原因为HBV感染激活12例,药物性肝损伤5例,淋巴瘤肝脏浸润2例,HEV感染2例;常规综合措施护肝治疗,结果11例生存,10例死亡【中位生存时间为14(4～40) d】;单因素分析显示生存与死亡患者血清AST、Cr、INR和MELD评分存在显著性差异(P<0.05),经Cox回归生存分析显示Cr和MELD评分是影响死亡的独立危险因素。结论 淋巴瘤患者在接受化疗期间需密切监测病毒学和肝功能变化,对合并HBV感染者,应及时预防性应用抗病毒药物。

Clinical feature and prognosis of lymphoma patients with chemotherapy-induced liver failure

Objective The aim of this summarize the clinical feature and prognostic factors of patients with liver failure induced by chemotherapy for lymphoma.Methods The clinical manifestations,laboratory tests and outcomes of liver failure after chemotherapy for lymphoma were analyzed retrospectively.Results 21 patients(15 males and 6 females)were included with the mean age of 55.6±15.2(29-76)years old,having underlying non-Hodgkin’s lymphoma in 20 cases and Hodgkin’s lymphoma in one;the rituximab and conventional chemotherapy were given,and the causes of liver failure were hepatitis B viral reactivation in 12,drug-induced liver injury in 5,hepatic lymphoma infiltration in 2 and hepatitis E infection in 2;all patients received conventional supporting therapy including artificial liver supporting system;11 patients survived and 10 died with median survival of 14(4-40)days;univariate analysis showed that serum AST,Cr,INR and MELD score were the risk factors of death,and Cox regression showed that serum Cr and the MELD score were the independent impacting predictors.Conclusions The liver function tests should be closely monitored in patients with lymphoma during chemotherapy,and antiviral therapy should be started prophylactically in patients with underlying HBV infection.