非小细胞肺癌靶向治疗相关肝损伤情况及其早期标志物的临床价值研究  

Liver injury associated with targeted therapy for non-small cell lung cancer and its clinical value of early markers

作　　者：鲁志兵[1] 占志强[1] 曾建伦 黄行志 李瑞娟 彭济勇 LU Zhibing;ZHAN Zhiqiang;ZENG Jianlun;HUANG Xingzhi;LI Ruijuan;PENG Jiyong(Department of Oncology,Pingxiang People's Hospital,Jiangxi Province,Pingxiang,Jiangxi,337000,China)

机构地区：[1]江西省萍乡市人民医院肿瘤科,江西萍乡337000

出　　处：《当代医学》2022年第13期13-17,共5页Contemporary Medicine

基　　金：江西省卫生健康委科技计划(SKJP220200599)。

摘　　要：目的探究非小细胞肺癌(NSCLC)靶向治疗相关肝损伤情况及其早期标志物的临床价值。方法选取2019年12月至2021年1月本院收治的90例NSCLC患者作为研究对象,按治疗方式的不同分为单纯化疗组(A组)、单纯靶向组(B组)和靶向化疗联合组(C组),每组30例。比较3组相关肝损伤情况及治疗前(T_(0))、治疗后1个月(T_(1))、治疗后2个月(T_(2))、治疗后3个月(T_(3))和治疗后6个月(T_(4))的肝损伤早期标志物并分析其评估早期肝损伤的灵敏度和特异性。结果C组肝损伤1级发生率(16.67%)低于A组(33.33%)和B组(50.00%),差异有统计学意义(P<0.05)。T_(1)~T_(4)时,丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、谷氨酰转肽酶(GT)、谷氨酸脱氢酶(GLDH)水平逐渐下降,且T_(1)~T_(3)时,ALT、AST、GLDH水平均高于T_(0)时,GT水平均低于T_(0)时(P<0.05);T_(1)~T_(4)时,对氧磷酶-1(PON-1)水平逐渐上升,且T_(1)~T_(4)时,PON-1水平均低于T_(0)时(P<0.05);T_(1)~T_(4)时,C组ALT、AST、GDH水平均高于A组、B组,且A组高于B组,C组PON-1水平低于A组、B组,且A组低于B组,差异有统计学意义(P<0.05)。ALT的诊断灵敏度为83.4%,特异度为50.1%;AST的诊断灵敏度为78.6%,特异度为65.0%;GT的诊断灵敏度为71.9%,特异度为74.0%;GLDH的诊断灵敏度为62.0%,特异度为81.1%;PON-1的诊断灵敏度为85.8%,特异度为54.1%;5项指标联合检测的诊断灵敏度为93.0%,特异度为63.2%。结论非小细胞肺癌靶向治疗、化学治疗和靶向联合化学治疗均可能导致肝损伤,其中靶向联合化学治疗导致肝损伤的可能性更大,程度更重;ALT、AST、GT、GLDH、PON-1可反映非小细胞肺癌靶向治疗相关肝损伤的情况,具有一定的诊断价值,可为NSCLC靶向治疗中早期防治肝损伤提供参考。Objective To explore the liver injury associated with targeted therapy for non-small cell lung cancer(NSCLC)and its clinical value of early markers.Methods A total of 90 patients with NSCLC treated in our hospital from December 2019 to January 2021 were selected as the research subjects,and they were divided into simple chemotherapy group(group A),simple targeted chemotherapy group(group B)and combined targeted chemotherapy group(group C)according to the treatment method,with 30 cases in each group.The related liver injury was compared among the three groups,and the early markers of liver injury before treatment(T_(0)),after 1 month treatment(T_(1)),after 2 months treatment(T_(2)),after 3months treatment(T_(3))and after 6 months(T_(4))treatment were compared among the three groups,and the sensitivity and specificity of evaluating early liver injury was analyzed.Results The incidence of grade 1 liver injury in group C(16.67%),which was lower than that of group A(33.33%)and group B(50.00%),the difference was statistically significant(P<0.05).From T_(1)to T_(4),the levels of alanine aminotransferase(ALT),aspartate aminotransferase(AST),glutamyl transpeptidase(GT)and glutamate dehydrogenase(GLDH)decreased gradually,and T_(1)to T_(3),the levels of ALT,AST and GLDH were higher than those at T_(0),the levels of GT was lower than that at T_(0)(P<0.05);and from T_(1) to T_(4),the level of paraoxonase-1(PON-1)increased gradually,and T_(1)to T_(4),the level of PON-1 were lower than those at T_(0)(P<0.05).The diagnostic sensitivity and specificity of ALT were83.4% and 50.1% respectively,the diagnostic sensitivity and specificity of AST were 78.6% and 65.0% respectively,the diagnostic sensitivity and specificity of GT were 71.9% and 74.0% respectively,the diagnostic sensitivity and specificity of GLDH were 62.0% and 81.1% respectively,the diagnostic sensitivity and specificity of PON-1 were 85.8%and 54.1% respectively,the diagnostic sensitivity of combined detection of five indicators were 93.0%and 63.2%.Conclusion Targeted t

关 键 词：非小细胞肺癌 靶向治疗 肝损伤 早期标志物 

分 类 号：R734.2[医药卫生—肿瘤]