含奥沙利铂联合方案引起肝功能异常的临床分析

 目的　观察含奥沙利铂联合化疗方案与非奥沙利铂方案对肿瘤患者肝功能的影响。方法　对2005年3月至2007年10月间42例出现化疗药物性肝功能异常的恶性肿瘤患者进行回顾性分析。所有患者均经组织学或细胞学确诊并接受单纯化疗，根据不同的肿瘤类型选择相应的化疗方案，化疗前肝功能均正常，同时排除伴有肝转移、乙肝和丙肝检测阳性、肝硬化等肝脏疾病的病例，其中22例接受含奥沙利铂联合化疗，均采用FOLFOX-4方案，其余20例采用不含奥沙利铂的联合化疗。观察止点为肝功能首次出现异常且在此之前化疗过程中未使用过保肝药物。观察指标包括ALT、AST、 TBIL、DBIL、IBIL、ALP、GGT，同时结合采用WHO不良反应分度标准进行评定。计量资料采用t检验，计数资料采用Wilcoxon秩和检验。结果　全组共接受90个疗程化疗，平均每例接受2.14个周期化疗后出现不同程度的肝损伤。化疗后有13例出现0度肝脏毒性、21例为Ⅰ度、7例为Ⅱ度、1例为Ⅲ度；化疗后以ALT和AST增高更显著（P＜0.05），其中含奥沙利铂的化疗方案较不含奥沙利铂方案对ALT和AST增高的影响更显著（P＜0.05），化疗对胆红素无显著影响。两亚组首次出现肝功能异常之前累计化疗疗程数以及不良反应分度的总体分布相似。结论　在保肝药干预之前，含奥沙利铂组较其他化疗方案更易引起肝功能损伤，主要表现为转氨酶的升高。

Clinical analysis of lver functional lesion caused by combination chemotherapy containing oxaliplatin

Objective To observe liver functional lesion caused by combination chemotherapy containing or not containing oxaliplatin. Methods Data from 42 patients with liver functional lesion caused by chemotherapy between March 2005 and October 2007 were analyzed. All patients were diagnosed through histology or cytology detection and received chemotherapy only. Different drugs were. admitted,based on different tumors. Before chemotherapy, each patient had normal liver function without liver lesions such as liver metastasis, Hepatitis B and C, hepatic cirrhosis, etc. Furthermore, 22 received FOLFOX-4 in containing oxaliplatin group while the remaining 20 received chemotherapy excluding oxaliplatin. When liver functional lesion without the influence of any liver protectant was first observed, ALT, AST, TBIL, DBIL, IBIL, ALP, GGT and the WHO criteria of liver toxicity were analyzed. T test and Wilcoxon rank sum test were used for data analysis. Results All together 90 cycles, median 2.14 cycles, were given. According to WHO criteria of liver toxicity, 13 cases were in grade O, 21 in grade Ⅰ, 7 in grade Ⅱ, and 1 in grade Ⅲ. ALT and AST were significantly high after chemotherapy(P <0.05). Moreover, ALT and AST were significantly higher in containing oxaliplatin group than non oxaliplatin group after chemotherapy(P <0.05). Chemotherapy had no influence on bilirubin. The population distribution of accumulative chemotherapy cycles and WHO criteria of liver toxicity was similar between two groups. Conclusion Before the intervention of liver protectant, combination chemotherapy containing oxaliplatin is more likely to have liver functional lesion than other chemotherapy without oxaliplatin. It mainly presents an increase in transaminase.