多烯磷脂酰胆碱联合双环醇治疗胃癌化疗导致的药物性肝损伤患者疗效及其对血清细胞因子和氧化应激指标水平的影响

目的 探讨应用多烯磷脂酰胆碱联合双环醇治疗胃癌化疗所致的药物性肝损伤(DILI)患者疗效及其对血清细胞因子和氧化应激指标的影响。方法 2017年5月～2019年5月我院收治的胃癌根治术后患者78例,给予奥沙利铂、多西他赛和氟尿嘧啶化疗。在化疗过程中出现DILI患者40例,被随机分为对照组(n=19)和观察组(n=21),给予对照组患者多烯磷脂酰胆碱治疗,给予观察组多烯磷脂酰胆碱联合双环醇片治疗,两组均观察4周。采用ELISA法检测血清肿瘤坏死因子-α(TNF-α)和白细胞介素-6(IL-6),采用硫代巴比妥酸法检测血清丙二醛(MDA),采用黄嘌呤氧化法检测血清超氧化物歧化酶(SOD)。采用卡氏功能状态(KPS)量表评估患者生存质量。结果 在治疗4周末,观察组血清丙氨酸氨基转移酶(ALT)水平为(33.5±7.9)U/L,显著低于对照组【(42.4±8.8)U/L,P<0.05】,血清天冬氨酸氨基转移酶(AST)水平为(34.4±5.7)U/L,显著低于对照组【(39.4±6.2)U/L,P<0.05】,血清碱性磷酸酶(ALP)水平为(60.6±14.2)U/L,显著低于对照组【(75.3±16.6)U/L,P<0.05】,而KPS评分为(64.1±17.2)分,显著高于对照组【(48.3±14.5)分,P<0.05】;联合组肝功能复常率为81.0%,显著高于对照组的63.2%(P<0.05);观察组血清TNF-α水平为(15.2±2.1)mg/L,显著低于对照组【(21.4±3.6)mg/L,P<0.05】,血清IL-6水平为(28.1±4.5)pg/mL,显著低于对照组【(46.2±5.9)pg/mL,P<0.05】;血清MDA水平为(5.1±0.8)nmol/mL,显著低于对照组【(5.9±0.7)nmol/mL,P<0.05】,而血清SOD水平为(2.3±0.5)U/mL,显著高于对照组【(1.8±0.4)U/mL,P<0.05】。结论 联合应用多烯磷脂酰胆碱和双环醇片治疗化疗药导致的DILI患者能改善肝功能,可能与抑制了氧化应激反应,降低了血清细胞因子水平有关,值得进一步研究。

Short-term efficacy of polyene phosphatidylcholine and bicyclol combination in treatment of gastric cancer patients with chemotherapy-induced liver injury

Objective The aim of this study was o investigate the short-term efficacy of polyene phosphatidylcholine and bicyclol combination in treatment of gastric cancer patients with chemotherapy-induced liver injury. Methods 78 patients with gastric cancer were admitted to our hospital between May 2017 and May 2019, and all of them underwent radical resection of gastric cancer and received chemotherapy. During the treatment, the drug-induced liver injuries (DILI) was found in 40 patients. Out of them, 19 received with polyene phosphatidylcholine and 21 with polyene phosphatidylcholine and bicyclol combination therapy for liver interleukin-6 (IL-6), malondialdehyde (MDA) function protection for 4 weeks. Serum tumor necrosis factor (TNF-α), and superoxide dismutase (SOD) levels were assayed, respectively. Results At the end of four week treatment, serum alanine aminotransferase level in the combination group was (33.5±7.9)U/L, significantly lower than 【(42.4±8.8)U/L, P<0.05】, serum aspartate aminotransferase level was (34.4±5.7)U/L, much lower than 【(39.4±6.2)U/L, P<0.05】, serum alkaline phosphatase level was (60.6±14.2)U/L, significantly lower than 【(75.3±16.6)U/L, P<0.05】, while Karnofsky performance status score was (64.1±17.2), much higher than 【(48.3±14.5), P<0.05】 in the control; the rate of liver function test normalization in the combination group was 81.0%, significantly higher than 63.2%(P<0.05) in the control; serum TNF-α level in the combination group was (15.2±2.1)mg/L, significantly lower than 【(21.4±3.6)mg/L, P<0.05】, serum IL-6 level was (28.1±4.5)pg/mL, significantly lower than 【(46.2±5.9)pg/mL, P<0.05】, serum MDA level was (5.1±0.8)nmol/mL, significantly lower than 【(5.9±0.7)nmol/mL, P<0.05】, while serum SOD level was (2.3±0.5)U/mL, much higher than 【(1.8±0.4)U/mL, P<0.05】 in the control. Conclusion The application of bicyclol combined with polyene phosphatidylcholine in treatment of patients with DILI could improve liver function recovery, which might be related to the inhibition of oxidative stress and cytokine burst.