原发性肝癌精准-动脉灌注化疗栓塞所致急性肝损伤最优保肝方案筛选  

Screening of optimal hepato-protective program for acute liver injury caused by a-TACE in primary liver cancer

作　　者：吴勇超[1] 李智岗[1] 赵阳[1] 李亚洲[1] 吴建华[1] 杨光[1] 武中林[1] WU Yongchao;LI Zhigang;ZHAO Yang;LI Yazhou;WU Jianhua;YANG Guang;WU Zhonglin(Department of Interventional Radiology,the Fourth Hospital of Hebei Medical Universtiy,Shijiazhuang 050011,China)

机构地区：[1]河北医科大学第四医院放射介入科,河北石家庄050011

出　　处：《实用放射学杂志》2020年第9期1469-1473,共5页Journal of Practical Radiology

基　　金：国家癌症中心肿瘤科研专项课题(NCC2017A26);河北省科技厅重点研发项目(18277744D);河北省中国医药管理局科研计划项目(2019135);河北省卫生和计划生育委员会医学科学研究重点课题计划项目(20170740)。

摘　　要：目的探讨原发性肝癌(PLC)精准-动脉灌注化疗栓塞(a-TACE)后不同保肝方案的成本-效果,为临床上最佳保肝治疗提供理论依据.方法选择PLC患者150例,采用完全随机化分为6组,每组25例.所有患者均采用a-TACE,术后保肝治疗采用2种药物联合分为6组.A组:抗感染类+肝细胞膜修复保护剂;B组:抗感染类+利胆类;C组:抗感染类+解毒类;D组:肝细胞膜修复保护剂+利胆类;E组:肝细胞膜修复保护剂+解毒类;F组:利胆类+解毒类.对比6组患者临床疗效、成本-效果比(CER)及药物不良反应.结果6组间比较患者介入术后第4天治疗总有效率有差异(P<0.05);组间比较A、B、C3组高于D、E、F 3组(P<0.05);A、B、C3组之间及D、E、F3组之间无差异(P>0.05).6组患者CER由低到高依次为E组、C组、A组、F组、B组、D组;增量CER由低到高依次为C组、A组、B组、D组、F组.6组患者敏感性分析,CER由低到高依次为E组、C组、A组、F组、B组、D组;增量CER由低到高依次为C组、A组、B组、D组、F组.结论经济、合理的抗感染类+解毒类保肝治疗可使a-TACE患者所致的急性肝损伤(ALI)获得了最大化的治疗收益.Objective To investigate the cost-effectiveness of different hepatoprotective drugs in primary liver cancer(PLC)after accurate-transcatheter arterial chemoembolization(a-TACE),and to provide the basis for the best clinical hepato-protective treatment.Methods A total of 150 patients with PLC were selected and randomized divided into the six groups with 25 in each group.All patients underwent a-TACE,and each group was treated with combination of two hepato-protection drugs after a-TACE.Anti-inflammatory and hepatocyte membrane repair protective agent were used in the group A;Anti-inflammatory and choleretic drug were used in the group B;Anti-inflammatory and detoxification drug were used in the group C.Hepatocyte membrane repair protective agent and choleretic drug were used in the group D;Hepatocyte membrane repair protective agent and detoxification drug were used in the group E;Choleretic drug and detoxification drug were used in the group F.Clinical efficacytcost-effectiveness ratio(CER)and adverse drug reactions were compared among the six groups.Results The total effective rates on the 4th day were statistically significant among the six groups(P<0.05);which were higher in the group A,B,C than in the group D,E,F(P<0.05);and there were no significant differences among the group A,B,C and the group D,E,F(P>0.05).The CER were increased gradually in the order of the group E,C,A,F,B and D.The incremental CER were higher in the order of the group C,A,B,D and F.Sensitivity analysis showed that the CER were increased gradually in the order of the group E,C,A,F,B and D;the incremental CER were higher in the order of the group C,A,B,D and F.Conclusion Economical and reasonable anti-inflammatory and detoxification hepatoprotective treatment could maximize the treatment benefit for acute liver injury(ALI)patients caused by a-TACE.

关 键 词：原发性肝癌 精准-动脉灌注化疗栓塞 疗效 成本-效果分析 

分 类 号：R735.7[医药卫生—肿瘤] R815[医药卫生—临床医学]