含奥沙利铂方案引起结直肠癌患者肝窦阻塞综合症的临床分析  

The clinical analysis of blue liver syndrome in patient with colorectal cancer caused by oxaliplatin-based chemotherapy

作　　者：徐敏[1] 乔桐杉[1] 

机构地区：[1]内蒙古巴彦淖尔市医院消化内科,内蒙古100150

出　　处：《中华胃肠内镜电子杂志》2016年第1期16-19,共4页Chinese Journal of Gastrointestinal Endoscopy(Electronic Edition)

摘　　要：目的探讨结直肠癌患者接受含奥沙利铂化疗方案后引起的肝脏毒性,血液毒性及肝窦阻滞综合症的发生率,评价含奥沙利铂化疗方案对肝脏耐受性的影响。方法回顾性分析内蒙古巴彦淖尔市医院消化内科2008年1月至2012年12月收治的56例行含奥沙利铂方案化疗的结直肠癌患者,分别评估患者化疗前后的肝功能、血常规、脾脏大小及远期疗效,并随访1年,观察中位无进展时间和中位生存时间。结果结直肠癌伴肝转移与不伴肝转移的患者在化疗前的基线白蛋白水平(40.68 g/L vs 43.41 g/L,P=0.0423)、谷丙、谷草转氨酶异常率(21.43%vs 2.22%,P=0.0214)及γ-谷氨酰转移酶异常发生率(46.43%vs 15.56%,P=0.004)有统计学差异。行含奥沙利铂方案化疗后肝转移患者白蛋白降低的发生率明显高于无肝转移组(42.86%vs 17.78%,P=0.0195);伴肝转移患者Ⅲ/Ⅳ度谷草转氨酶升高的发生率高于无肝转移组(21.43%vs 6.67%,P=0.041);初次血小板减少发生的时间肝转移组明显早于无肝转移组(4.07月vs 5.50月,P=0.0408);脾脏肿大的发生率在无肝转移的患者中更高(44.44%vs 21.43%,P=0.0458),无转移的患者中位生存期为37月,肝转移无手术患者中位生存期为6.5月。结论接受含奥沙利铂的化疗方案后,肝窦阻滞综合症在伴有肝转移的患者中更明显,肝脏对化疗药物的耐受性明显减退。Objective This study was performed to investigate the influence of oxaliplatin-based chemotherapy in the liver tolerance of colorectal cancer patients including hematologic toxicity, liver toxicity, blue liver syndrome. Methods Fifty-six patients diagnosed and treated with oxaliplatin-based chemotherapy in our hospital from January 2008 to December 2012 were analyzed retrospectively. Patients were assessed of liver function, hematologic toxicity, spleen size and long term effect, and were follow-up for one year to observe the media no progressive time and media survival time. Results Before chemotherapy, the baseline of albumin and the incidence of elevated aminotransferases and γ/-GT in colorectal cancer patients with liver metastasis were significantly different from patients without liver metastases ,40.68 g/L vs 43.41 g/L, P = 0. 0423;21.43 % vs 2. 22 % , P = 0. 0214 ;46.43 % vs 15.56% , P = 0. 004, respectively. Decreased albmnin was more likely to occur in patients with liver metastasis,42.86% vs 17.78% ,P = 0. 0195. Ⅲ/Ⅳ elevated of AST in patients with liver metastases was higher and statistically significant,21.43% vs 6. 67%, P = 0.041. The time of initial thrombocytopenia in colorectal cancer patients with liver metastasis was significantly earlier （4.01 vs 5. 10,P = 0. 0408）. The incidence of splenomegaly in patients without liver metastases was higher than the patients with liver metastases. The median survival time of live metastases was 37 months, without liver metastases and no surgery was 6.5 mouths. Conclusion Blue liver syndrome was increased after oxaliplatin-based chemotherapy, especially in the patients with liver metastasis,liver tolerance was reduced significantly.

关 键 词：结直肠癌 奥沙利铂 肝窦阻滞综合症 

分 类 号：R735.34[医药卫生—肿瘤]