前列腺癌患者联合雄激素阻断治疗中的肝功能异常与处理  

Liver dysfunction and the treatment in combined androgen blockade for patients with prostate cancer

作　　者：姜昊文[1] 张元芳[1] 丁强[1] 姚孟树[1] 吴忠[1] 方祖军[1] 王继功[1] 孙剑良[1] 瞿连喜[1] 

机构地区：[1]复旦大学附属华山医院泌尿外科,上海200040

出　　处：《中华泌尿外科杂志》2005年第1期49-50,共2页Chinese Journal of Urology

摘　　要：目的　探讨前列腺癌联合雄激素阻断治疗中出现的肝功能异常和治疗。　方法　 2 3例病理确诊的前列腺癌患者 ,年龄 6 3～ 80岁 ,平均 73岁。均行双侧睾丸切除加氟他胺 2 5 0mg每日 3次 ,治疗后平均 6 .2个月出现肝功能异常。治疗前丙氨酸氨基转移酶 (ALT)为 (37± 7.2 )U/L ,17例ALT升至(6 3.5± 7.5 3)U/L ,无黄疸 ;垂盆草冲剂 1包每日 3次 ,VitC 0 .2g及VitBco 2片每日 2次治疗 ;6例ALT(87.2± 7.34)U/L伴黄疸者 ,停用氟他胺 ,5 %GS 2 5 0ml加肝泰乐 1.2g和 (或 ) 5 %GNS 2 5 0ml加泰特0 .6～ 1.2g静脉点滴每日 1次 ,持续 4周。每周随访肝功能。　结果　 17例肝功能轻度损害者经上述治疗 1～ 2个月后 ,肝功能恢复正常 ;6例重症者中 4例ALT和总胆红素均恢复正常 ,2例ALT和黄疸出现好转 ,但未正常。 4例转移性肝癌伴骨转移患者平均生存 2 .1年后死亡。　结论　双侧睾丸切除加氟他胺治疗中应密切监测肝功能 ,可预先保肝治疗。Objective To evaluate the incidence of liver dysfunction and the relevant treatment in patients with prostate cancer with combined androgen blockade. Methods Twenty three patients (mean age,73 years;range,63-80 years) with histologically confirmed prostate cancer showed liver dysfunction during the course of combined blockade with bilateral orchiectomy and flutamide at a dose of 250 mg,3 times per day.After 6.2 months of therapy, ALT level was increased from pre treatment of (37±7.2)U/L to (63.5±7.53)U/L in 17 patients without jaundice and (87.2±7.34)U/L in 6 patients with jaundice.In the 17 patients without jaundice,herbal medicines were used together with vitamin C and vitamin B complex for 1-2 months (first line therapy).In the 6 severely disordered patients,flutamide was stopped, while glucurolactone at a dose of 1.2 g and (or) TAD of 0.6-1.2 g were administered intravenously per day for 4 weeks (second line therapy).Liver function was monitored every week. Results The 17 patients with mild liver dysfunction recovered after application of first line therapy for 1-2 months.The other 6 patients with relatively severe dysfunction had recovery or improvement with additional second line therapy.Of these patients,4 died of hepatic metastases after 2.1 years. Conclusions It is necessary to monitor liver function during the course of combined androgen blockade and to adopt liver protecting therapy for patients with prostate cancer who previously had hepatitis.

关 键 词：前列腺癌 雄激素 治疗 肝功能异常 

分 类 号：R737.25[医药卫生—肿瘤]