含奥沙利铂化学治疗方案对Ⅱ期结直肠癌患者肝纤维化的影响  

Effect of oxaliplatin-based adjuvant chemotherapy on liver fibrosis in patients with stage Ⅱ colorectal cancer

作　　者：梁承华 郑晓明 张亚琴[2] 雷普润 蔡梓凯 魏波[1] Chenghua Liang;Xiaoming Zheng;Yaqin Zhang;Purun Lei;Zikai Cai;Bo Wei(Department of Gastrointestinal Surgery, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, China)

机构地区：[1]中山大学附属第三医院胃肠外科,广州510630 [2]中山大学附属第三医院放射科,广州510630

出　　处：《新医学》2019年第6期427-431,共5页Journal of New Medicine

基　　金：广东省科技计划项目(2017A010103009,2017B020227009);中山大学重大项目培育和新兴交叉学科资助计划(16ykjc23)

摘　　要：目的探讨含奥沙利铂的化学治疗方案对Ⅱ期结直肠癌患者肝纤维化的影响。方法收集123例Ⅱ期结直肠癌患者的数据,将接受含奥沙利铂化学治疗方案者纳入化学治疗组(85例),无接受化学治疗或未完成化学治疗疗程者纳入非化学治疗组(38例),比较2组术前及术后3个月、6个月、1年的肝损害情况,包括谷草转氨酶-血小板比指数(APRI)、基于因子的纤维化指数(FIB-4)、肝体积、脾体积和肝密度,及其他不良反应情况。结果化学治疗组患者术后3个月、6个月和12个月的APRI值和FIB-4均较术前升高(P均<0.017);肝密度和脾体积在术后3、6个月较术前升高(P均<0.017),术后12个月时降至术前水平;肝体积术前术后比较差异无统计学意义(P>0.017)。非化学治疗组的APRI、FIB-4、肝密度、肝体积和脾体积术前术后比较差异均无统计学意义(P均>0.017)。化学治疗组患者治疗后的APRI和肝密度值高于非化学治疗组患者(P均<0.05);化学治疗组患者术后6个月(即化学治疗结束时)的FIB-4高于非化学治疗组患者(P<0.05)。结论Ⅱ期结直肠癌术后使用含奥沙利铂的化学治疗方案会导致肝纤维化,其影响在化学治疗结束时达到峰值,但或可在术后1年内逐渐恢复。Objective To evaluate the effect of oxaliplatin-containing adjuvant chemotherapy on the liver fibrosis of patients with stage Ⅱ colorectal cancer.Methods Clinical data of 123 patients with stage Ⅱ colorectal cancer were collected. All patients were divided into the chemotherapy group (chemotherapy regimen containing oxaliplatin, n = 85) and the non-chemotherapy group (did not receive chemotherapy or failed to complete the chemotherapy, n = 38). Aspartate aminotransferase-to-platelet ratio index (APRI), the fibrosis index based on the four factors (FIB-4), liver volume, spleen volume and liver density, and other adverse reactions were statistically compared between two groups before and 3 months, 6 months and 1 year after operation, respectively.Results In the chemotherapy group, APRI and FIB-4 were significantly increased at postoperative 3, 6 and 12 months (all P < 0.017). Liver density and spleen volume were considerably increased at 3 and 6 months after operation (all P < 0.017), whereas decreased to preoperative level at postoperative 12 months. The liver volume did not significantly differ before and after operation (P > 0.017). In the non-chemotherapy group, APRI, FIB-4, liver density, liver volume and spleen volume did not significantly differ before and after operation (all P > 0.017). The APRI and liver density in the chemotherapy group were remarkbaly higher than those in the non-chemotherapy group (both P < 0.05). The FIB-4 score in the chemotherapy group at postoperative 6 months (at the end of chemotherapy) was significantly higher than that in the non-chemotherapy group (P < 0.05).Conclusions Application of oxaliplatin-based chemotherapy affects the liver fibrosis of patients with stage Ⅱ colorectal cancer. The effect reaches the peak at the end of chemotherapy. However, the liver fibrosis of patients can gradually recover within 1 year after surgery.

关 键 词：结直肠癌Ⅱ期 奥沙利铂 谷草转氨酶-血小板比指数 基于因子的纤维化指数 肝纤维化 药物性肝损伤 

分 类 号：R735.34[医药卫生—肿瘤] R575.2[医药卫生—临床医学]