结直肠癌患者化疗后肝功能异常危险因素分析

来源 :肿瘤研究与临床 | 被引量 : 0次 | 上传用户:xiaok131
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目的:探讨结直肠癌患者接受含奥沙利铂化疗方案治疗后出现肝功能异常的危险因素、临床特征及预后,为临床诊疗提供相关依据。方法:回顾性分析山西医科大学第一医院2017年10月至2019年5月收治的选用XELOX(奥沙利铂+卡培他滨)方案或mFOLFOX6(奥沙利铂+亚叶酸钙+5-氟尿嘧啶)方案化疗的108例结直肠癌患者临床资料,根据化疗后肝功能指标分为肝功能异常组和肝功能正常组,观察指标包括丙氨酸氨基转移酶、天冬氨酸氨基转移酶、总胆红素、结合胆红素、碱性磷酸酶、γ谷氨酰转肽酶。分析常用含奥沙利铂方案化疗后肝功能异常的临床特征,并采用多因素logistic回归分析可能导致肝功能异常的相关因素。结果:108例患者化疗后肝功能异常者67例(62.0%)。肝功能异常分级以1、2级为主,其中1级49例(73.1%),2级16例(23.9%)。化疗后肝功能异常多开始于1~4个周期,其中1个周期22例(32.8%),2个周期17例(25.4%),3个周期20例(29.8%),4个周期4例(6.0%)。单因素分析显示,年龄6个、选用mFOLFOX6方案、未预防给予保肝药物与肝功能异常发生有关(n χ2值分别为3.910、4.799、12.861、4.044;均n P<0.05);多因素logistic回归分析结果表明,采用mFOLFOX6方案和未预防给予保肝药物为影响肝功能异常发生的独立危险因素(n HR=3.405,95% n CI 1.266~9.159,n P=0.015;n HR=2.348,95% n CI 1.012~5.477,n P=0.047)。n 结论:对于化疗后肝功能异常发生风险高的结直肠癌患者,在使用含奥沙利铂方案化疗时,建议优先选择XELOX方案,并行预防性保肝治疗。“,”Objective:To investigate the risk factors, clinical features and prognosis of abnormal liver function after receiving oxaliplatin-containing chemotherapy regimen in patients with colorectal cancer, and to provide a relevant basis for clinical diagnosis and treatment.Methods:The clinical data of 108 colorectal cancer patients who received XELOX (oxaliplatin+capecitabine) or mFOLFOX6 (oxaliplatin+leucovorin+ 5-fluorouracil) chemotherapy regimen from October 2017 to May 2019 in the First Hospital of Shanxi Medical University were analyzed retrospectively. According to the liver function indexes after chemotherapy, the patients were divided into abnormal liver function group and normal liver function group. The observation indexes included alanine aminotransferase, aspartate aminotransferase, total bilirubin, direct bilirubin, alkaline phosphatase, γ-glutamyl transpeptidase. The clinical characteristics of liver dysfunction after oxaliplatin-containing chemotherapy were analyzed and the related factors that might lead to liver dysfunction were analyzed by using multivariate logistic regression analysis.Results:Among 108 patients receiving chemotherapy, there were 67 (62.0%) cases of abnormal liver function. The main grades of liver dysfunction were grade 1 and grade 2, including 49 cases of grade 1 (73.1%) and 16 cases of grade 2 (23.9%). After chemotherapy, the abnormal liver function usually began in 1-4 cycles, of which 22 cases were 1 cycle (32.8%), 17 cases were 2 cycles (25.4%), 20 cases were 3 cycles (29.8%), and 4 cases were 4 cycles (6.0%). Univariate analysis showed that the age 6, the use of mFOLFOX6 regimen, unprotected hepatoprotective drugs were related to liver dysfunction ( n χ2 values were 3.910,4.799, 12.861, 4.044; all n P < 0.05). Multivariate logistic regression analysis showed that mFOLFOX6 regimen and unprotected hepatoprotective drugs were independent risk factors of abnormal liver function ( n HR = 3.405, 95% n CI 1.266-9.159, n P = 0.015; n HR = 2.348, 95% n CI 1.012-5.477, n P = 0.047).n Conclusions:For patients with colorectal cancer who have a high risk of liver dysfunction after chemotherapy, it is recommended to prefer XELOX regimen among oxaliplatin-containing chemotherapy regimens and to take preventive liver protection treatment.
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1952年11月出生,山西大同人,1968年8月参加工作,1970年4月加入中国共产党,山西省委党校公共管理专业毕业,研究生学历,高级经济师,高级工程师,现任大同煤矿集团公司董事长,党