目的 对某院纳入临床路径的乳腺癌、结直肠癌术后辅助化疗患者发生药物性肝损伤(drug-induced liver injury,DILI)的情况进行调查分析,初步探讨预防性使用保肝药是否可纳入临床路径。方法 回顾了2015年1月~2017年3月205例病例,将患者按是否预防性使用保肝药分为两组,用SPSS19.0软件对患者DILI的发生率、发生时间、严重程度及转归,是否预防性使用保肝药等信息进行统计分析,并对患者肝损伤相关危险因素进行Logistic回归分析,探讨预防性使用保肝药的必要性及给药时机。结果 在205例患者中有43例(20.98%)的患者预防性使用了保肝药,无DILI发生;未预防性使用组DILI的发生率为4.88%。在第一、第二周期化疗前两组均无DILI发生,只有在第三周期化疗前预防性使用保肝药组与未预防性使用组肝损伤的发生率有统计学差异(P<0.05)。多因素分析显示,预防用药为肝损伤的保护因素(OR=0.07)。结论 乳腺癌、结直肠癌术后辅助临床路径治疗的第一、二周期加强肝功能监测即可,出现肝功能异常者在下一周期用药前可预防性给予保肝药。
Abstract
OBJECTIVE To investigate drug-induced liver injury(DILI) in clinical pathway on patients with breast cancer and colorectal cancer and to explore whether the prophylactic use of hepatoprotective drugs can be included in the clinical pathway. METHODS Two hundred and five cases from January 2015 to March 2017 were selected. The patients were divided into two groups according to the prophylactic use of hepatoprotective drug. The incidence, time, severity and outcome of DILI, prophylactic use of hepatoprotective drugs were investigated. DILI related risk factors were screened and analyzed by logistic linear regression to discuss the necessity and opportunity of prophylactic use of hepatoprotective drugs. RESULTS Forty-three(20.98%) patients without DILI had prophylactic use of hepatoprotective drugs in 205 cases. The incidence of DILI in the non-prophylactic group was 4.88%. Both two groups hadn't occurred DILI during the first and second cycles of chemotherapy. However, there was a statistically significant difference in the rate of DILI between the prophylactic and non-prophylactic use of hepatoprotective drugs groups in the third cycles of chemotherapy(P<0.05). Multifactor analysis showed that prophylactic use of hepatoprotective drugs was a protective factor for the DILI. CONCLUSION The liver function should be reinforced during the first and second cycles of chemotherapy. The hepatoprotective drugs could be used prophylactically before the next period of chemotherapy if patient with abnormal liver function.
关键词
乳腺癌 /
结直肠癌 /
保肝药 /
药物性肝损伤 /
临床路径
{{custom_keyword}} /
Key words
breast cancer /
colorectal cancer /
hepatoprotective drug /
drug induced liver injury /
clinical pathway
{{custom_keyword}} /
中图分类号：
R969.3
{{custom_clc.code}}
({{custom_clc.text}})
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
参考文献
[1] RAO Y F, ZHENG F Y, ZHANG X G. The immunological mechanism of drug induced liver injury[J]. Chin Pharm J(中国药学杂志),2008,43(16):1207-1210.
[2] CSCO, CSH, UCLI. Expert panel consensus statement on prevention and standardized treatment of drug-induced liver injury in patients with blood diseases[J]. Chin J Hematol(中华血液学杂志),2016,37(6):441-451.
[3] YU Y C, MAO Y M, CHEN C W, et al. CSH Guidelines for the diagnosis and treatment of drug-induced liver injury[J]. Hepatol Int,2017,11(3):221-241.
[4] ROTH A D, LEE M Y. Idiosyncratic drug-induced liver injury(IDILI):potential mechanisms and predictive assays[J]. Biomed Res Int,2017,2017(1):1-23.
[5] YUWEN L X,LIANG P,YUAN Y H, et al. One case of patient with drug-induced liver injury induced by tumor chemotherapy[J]. Chin J New Drug Clin Reme(中国新药与临床杂志),2016,35(9):680-682.
[6] ROBERT J F. Pathogenesis of idiosyncratic drug-induced liver injury and clinical perspectives[J]. Gastroenterology,2014,146(4):914-928.
[7] SUN S J,ZHANG W. Key Points for the Treatment of Common Diseases. Phymatology(常见疾病药物治疗要点系列丛书肿瘤分册)[M]. Beijing:People's Medical Publishing House,2015:235-236.
[8] YU L C,MAO Y M,CHEN C W. Guidelines for the management of drug-induced liver injury[J]. J Chin Hepatol(临床肝胆病杂志),2015,31(11):1752-1769.
[9] WU Y Q,WANG S R,YU B, et al. Investigation and analysis on application of hepatoprotective drugs in 124 in-patients with drug-induced liver injury [J]. Eval Anal Drug-Use Hosp Chin(中国医院用药评价与分析),2017,17(1):99-101,104.
[10] FONTANA R J,HAYASHI P H,GU J, et al. Idiosyncratic drug-induced liver injury is associated with substantial morbidity and mortality within 6 months from onset[J]. Gastroenterology,2014,147(1):96-108.
[11] XIA Z, CHEN Q. Occurrence and prevention of chemotherapy induced liver injury in patients with hematologic malignancy[J]. J Int Med Concept Prac(内科理论与实践), 2015, 10(5):364-366.
{{custom_fnGroup.title_cn}}
脚注
{{custom_fn.content}}
基金
国家自然科学基金项目资助(81703514)
{{custom_fund}}
PDF(995 KB)
