异甘草酸镁联合还原型谷胱甘肽对肝细胞癌肝切除患者的应用价值

背景与目的:目前,手术切除仍然是肝细胞癌(肝癌)治疗的首选方法,然而,肝脏缺血再灌注损伤(HIRI)是肝脏切除难以避免的并发症,并且严重影响患者疗效和预后。由于氧化应激和炎症是诱导HIRI的重要机制,故本研究探讨抗炎类护肝药异甘草酸镁联合抗氧化剂还原型谷胱甘肽在肝癌肝切除术患者中的应用效果。方法:选择2016年3月-2019年3月间90例行肝切除手术治疗的肝癌患者随机分为对照组与观察组,每组45例。对照组术后采用静脉滴注还原型谷胱甘肽,观察组术后采用静脉滴注异甘草酸镁联合还原型谷胱甘肽,均为每天1次,连续7 d。比较两组患者的相关临床指标、术前与术后3、7 d的氧化应激与炎性因子水平以及术后1个月内的并发症发生情况。结果:两组患者术前一般资料、手术方式、肝切除范围以及肝功能、氧化应激与炎症因子指标均无统计学差异(均P>0.05)。所有患者手术均顺利完成,两组肝门阻断时长、手术时间和术中出血量差异均无统计学意义(均P>0.05)。与对照组比较,观察组术后3、7 d的肝功能指标明显优于对照组(均P<0.05);超氧化物岐化酶、还原型谷胱甘肽过氧化物酶水平明显高于对照组,而丙二醛水平明显低于对照组(均P<0.05);C反应蛋白、白细胞介素6、肿瘤坏死因子α低于对照组(均P<0.05)。两组均未见皮疹、瘙痒或过敏症状发生。观察组术后1个月内肝功能衰竭发生率明显低于对照组(4.4% vs.11.1%,P<0.05)。结论:异甘草酸镁联合还原型谷胱甘肽对肝癌肝切除术患者的肝功能具有明显保护作用,且优于单纯抗氧化治疗,该作用可能与抗炎抗氧化双重作用后有效抑制HIRI有关。

Application value of magnesium isoglycyrrhizinate plus reduced glutathione in hepatocellular carcinoma patients undergoing hepatectomy

Background and Aims:At present,surgical resection is still the first therapeutic option for hepatocellular carcinoma (HCC).However,the hepatic ischemia-reperfusion injury (HIRI) is difficult to avoid after hepatectomy,which severely influence the efficacy and outcomes of the patients.Given the oxidative stress and inflammation playing critical roles in the mechanism for HIRI,this study was designated to examine the effects of using the anti-inflammatory liver protective drug magnesium isoglycyrrhizinate combined with the antioxidant reduced glutathione on HCC patients undergoing liver resection.Methods:Ninety HCC patients scheduled to undergo liver resection from March 2016 to March 2019 were enrolled and randomly allocated to control group and observation group,with 45 cases in each group.Patients in control group were given reduced glutathione by intravenous infusion after operation,and those in observation group received intravenous infusion of magnesium isoglycyrrhizinate plus reduced glutathione after operation.Both regimens were administered once per day for 7 d.with 45 cases in each group.The main clinical variables,the levels of indexes for oxidative stress and inflammatory cytokines on postoperative day (POD) 3 and 7,as well as the incidence of postoperative complications were compared between the two groups of patients.Results:There were no significant differences in preoperative data,surgery type and liver resection scope as well as the levels of indexes for oxidative stress and inflammatory cytokines between the two groups of patients before operation (all P>0.05).The operations were successfully completed in in all patients,and there were no significant differences in time of hepatic portal occlusion,operative time and intraoperative blood loss between the two groups (all P>0.05).In observation group versus control group,the liver function parameters on POD 3 and 7 were all superior to those in control group (all P<0.05);the levels of superoxide dismutase and reduced glutathione peroxidase were significantly increased,while the level of malondialdehyde was significantly decreased (all P<0.05);the levels of C-reaction protein,interleukin-6 and tumor necrosis factor-α were significantly reduced (all P<0.05).No rash,pruritus or allergy occurred in both groups.The incidence of liver failure within postoperative one month in observation group was significantly lower than that in control group (4.4% vs.11.1%,P<0.05).Conclusion:Magnesium isoglycyrrhizinate combined with reduced glutathione can protect the liver function of HCC patients undergoing hepatectomy,which is superior to that using antioxidant alone.This effect may be achieved by the double action of anti-oxidative stress and anti-inflammation,which can effectively suppress the HIRI.