载药微球的TACE与碘化油乳剂的TACE对肝纤维化的影响  

Effect of TACE with drug-loaded microspheres versus with iodinated oil emulsion on liver fibrosis

作　　者：韩大千 李浩[1] 王满周 梁超 王嘉铖 许文泽 牛洋洋 邝东林 任建庄[1] 段旭华[1] Han Daqian;Li Hao;Wang Manzhou;Liang Chao;Wang Jiacheng;Xu Wenze;Niu Yangyang;Kuang Donglin;Ren Jianzhuang;Duan Xuhua(Department of Interventional Radiology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第一附属医院放射介入科,郑州450000

出　　处：《中华肝胆外科杂志》2024年第10期738-743,共6页Chinese Journal of Hepatobiliary Surgery

基　　金：河南省医学科技攻关省部共建重大项目(SBG J20202100);河南省重大科技专项(221100310100)。

摘　　要：目的对比载药微球的TACE(D-TACE)与碘化油乳剂的TACE(cTACE)治疗中晚期肝细胞癌时,对肝纤维化的影响。方法回顾性收集2019年10月至2020年9月在郑州大学第一附属医院采用D-TACE或cTACE治疗的113例原发性肝细胞癌患者的临床资料,其中男性96例,女性17例,年龄(56.8±9.8)岁。针对治疗方案的不同,分为两组:D-TACE组(n=57)和cTACE组(n=56)。对比两组患者术前、首次TACE术后1个月、第二次TACE术后1个月和首次TACE术后12个月4个时间点的肝纤维四项、纤维化指数(FIB-4)、血小板比率指数(APRI)、肝脏硬度值(LSM)等指标。以门诊复查或电话沟通方式进行随访,随访患者的生存情况。对比两组患者的肿瘤无进展生存时间、接受TACE次数等临床资料。结果观察期内D-TACE组接受治疗(2.84±1.12)次,cTACE组为(4.05±1.44)次,差异有统计学意义(t=4.94,P<0.001)。D-TACE组和cTACE组的中位无进展生存时间分别为10.0个月和5.0个月,差异有统计学意义(P<0.001)。第2次TACE术后1个月以及首次TACE术后12个月时,cTACE组患者的血清肝纤维四项指标均高于D-TACE组,差异均具有统计学意义(均P<0.05)。第2次TACE治疗后1个月和首次TACE术后12个月时,cTACE组患者的APRI、FIB-4、LSM均高于D-TACE组,差异均具有统计学意义(均P<0.05)。结论D-TACE组1年内接受TACE治疗的次数少于cTACE组,且D-TACE组肝纤维化加重程度低于cTACE组。ObjectiveTo compare the effects of drug-loaded microsphere TACE(D-TACE)and iodinated oil emulsion TACE(cTACE)on liver fibrosis in the treatment of advanced hepatocellular carcinoma(HCC).MethodsClinical data of 113 patients with HCC treated with D-TACE or cTACE at the First Affiliated Hospital of Zhengzhou University from October 2019 to September 2020 were retrospectively analyzed,including 96 males and 17 females,aged(56.8±9.8)years old.According to treatment protocol,patients were divided into two groups:the D-TACE group(n=57)and the cTACE group(n=56).Liver fibrosis panel,fibrosis index(FIB-4),aspartate aminotransferase to platelet ratio index(APRI),and liver stiffness measurement(LSM)were compared between the groups at four timepoints:pre-treatment,one month after the first TACE,one month after the second TACE,and 12 months after the first TACE.Follow-ups were conducted through outpatient visits or telephone reviews to assess patient survivals.Data including the progression-free survival(PFS)and number of TACE sessions were compared between the two groups.ResultsThe D-TACE group received 2.84±1.12 sessions of treatment during the observation period,compared to 4.05±1.44 sessions of cTACE group(t=4.94,P<0.001).The median PFS in D-TACE and cTACE groups were 10.0 and 5.0 months,respectively(P<0.001).At one month after the second TACE and at 12 months after the first TACE,patients in cTACE group had a higher serum levels of fibrosis markers including hyaluronic acid,type IV collagen,type III procollagen N peptide and laminin than those in D-TACE group(all P<0.05).At the same timepoints,patients in cTACE group also had higher APRI,FIB-4 and LSM than those in D-TACE group(all P<0.05).ConclusionCompared to cTACE,patients in D-TACE group received fewer sessions of treatment during the first year after initial TACE,and the degree of liver fibrosis was also lower in D-TACE group.

关 键 词：肝肿瘤 化疗栓塞 肝功能 肝纤维化 

分 类 号：R575.2[医药卫生—消化系统] R735.7[医药卫生—内科学]