不同乳腺癌化疗方案致药物性肝损伤的比较  

Comparison of drug-induced liver injury caused by different chemotherapy regimens against breast cancer

作　　者：丁晓霞[1] 赵艳萍[1] 白兆琴[1] 杨华[1] 姜晓燕[2] 金育忠[1] DING Xiao-xia;ZHAO Yan-ping;BAI Zhao-qin;YANG Hua;JIANG Xiao-yan;JIN Yu-zhong(Department of Pharmacy;Department of Galactophore,Gansu Provincial Cancer Hospital,Gansu Lanzhou 730000,China)

机构地区：[1]甘肃省肿瘤医院药学部,甘肃兰州730050 [2]甘肃省肿瘤医院乳腺科,甘肃兰州730050

出　　处：《中国医院药学杂志》2018年第19期2038-2041,共4页Chinese Journal of Hospital Pharmacy

基　　金：甘肃省卫生行业科研计划管理项目(编号:GWGL2014-32)

摘　　要：目的:探讨3种不同乳腺癌化疗方案致药物性肝损伤的特点,为后续保肝治疗提供参考。方法:回顾性分析某院2010年1月-2014年12月纳入临床路径病种行首次化疗的乳腺癌病历,收集病例信息,统计不同化疗方案致药物性肝损伤的发生率、严重程度、临床类型以及患者特点和预后情况。结果:该院3种乳腺癌化疗方案的肝损伤发生率分别为:5.7%(CEF方案:环磷酰胺+表柔比星+5-氟尿嘧啶)、14.9%(TC方案:多西他赛+环磷酰胺)、4.0%(AC方案:环磷酰胺+吡柔比星),其中TC方案的肝损伤发生率与CEF方案和AC方案比较差异有显著性(P<0.05);3种方案致肝损伤的严重程度主要集中在1级和2级肝损伤,但TC方案还导致了3级肝损伤;而在肝损伤类型方面,CEF方案所致肝损伤多表现为胆汁淤积型肝损伤(77.8%),TC方案多表现为混合型肝损伤(60.0%),AC方案多表现为肝细胞损伤型肝损伤(66.7%),3种化疗方案所致的肝损伤均能很好地治愈或转归。结论:在3种乳腺癌化疗方案所致的肝损伤中TC方案所致肝损伤的发生率和严重程度均较高,各个方案所致肝损伤的类型各有特点,临床可根据其特点进行肝损伤的针对性防治。OBJECTIVE To investigate the characteristics of drug-induced liver injury（DILI）caused by three different breast cancer chemotherapy regimens,and provide a reference for the follow-up of liver protection.METHODS A retrospective analysis was performed in our hospital from January 2010 to December 2014 to include clinical pathology of breast cancer chemotherapy for the first time,to collect case information,summarize the incidence,severity,clinical type and patient characteristics and prognosis of DILI induced by different chemotherapy regimens.RESULTS The incidence rates of liver injury in three breast cancer chemotherapy regimens in our hospital were 5.7%（CEF regimen）,14.9%（TC regimen）and 4.0%（AC regimen）,respectively.And the incidence rate of hepatic injury in TC regimen was significantly different from those in CEF regimen and AC regimen（P〈0.05）.The severity of liver damage caused by the three schemes mainly focused on grade 1 and2 liver injuries,but the TC regimen also resulted in grade 3 liver injury.In the type of liver injury,CEF-induced DILI mostly showed cholestatic liver injury（77.8%）,DILI caused by TC chemotherapy was mainly manifested as mixed liver injury（60.0%）,DILI caused by AC chemotherapy mainly manifested as hepatocellular injury（66.7%）.Liver damage caused by the three chemotherapy regimens were well cured or had good prognosis.CONCLUSION The incidence and severity of liver damage caused by TC regimen are higher among three kinds of breast cancer chemotherapy regimens.Each type of liver injury caused by each regimen has its own characteristics.Clinicians can choose prevention and treatment for liver injury according to its characteristics.

关 键 词：乳腺癌 化疗方案 药物性肝损伤 保肝药物 

分 类 号：R969[医药卫生—药理学]