乳腺癌、结直肠癌临床路径治疗中药物性肝损伤情况分析  

Analysis of Drug-Induced Liver Injury in Clinical Pathway on Patients with Breast Cancer and Colorectal Cancer

作　　者：朱亚宁[1] 李黎[1] 周楠[1] 王宏雅 左燕[1] 张鹏[1] ZHU Ya-ning;LI Li;ZHOU Nan;WANG Hong-ya;ZUO Yan;ZHANG Peng(Department of Pharmacy,Shaanxi Provincial People＇s Hospital,Xi ＇an 710068,China)

机构地区：[1]陕西省人民医院药学部,西安710068

出　　处：《中国药学杂志》2018年第14期1230-1233,共4页Chinese Pharmaceutical Journal

基　　金：国家自然科学基金项目资助(81703514)

摘　　要：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。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 path- way. 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, proph- ylactic use of hepatoprotective drugs were investigated. DILI related risk factors were screened and analyzed by logistic linear re- gression 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 DIM during the first and second cycles of chemotherapy. How- ever, there was a statistically significant difference in the rate of DILI between the prophylactic and non-prophylactic use of hepa- toprotective drugs groups in the third cycles of chemotherapy （P 〈 0.05 ）. Muhifactor analysis showed that prophylactic use of hepatoprotective drugs was a protective factor for the DILL 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 

分 类 号：R969.3[医药卫生—药理学]