乌司他丁在原发性肝癌术后化疗中的作用

Effects of ulinastatin on chemotherapy after resection of hepatocellular carcinoma

目的:探讨乌司他丁对原发性肝癌术后化疗中氧自由基、肝功能和免疫功能的影响。方法:选择原发性肝癌切除术后行门静脉灌注化疗(PVI)和门静脉+肝动脉灌注化疗(PVI+HAI)的患者55例,随机分为治疗组(n=30,PVI 15例,PVI+HAI 15例)和对照组(n=25,PVI 15例,PVI+HAI 10例)。治疗组在化疗时连续使用乌司他丁7 d,每日20万单位微泵持续滴注,检测和分析化疗前、后不同时期丙二醛(MDA)、超氧化物歧化酶(SOD)、肝功能和免疫功能的变化。对照组不用乌司他丁。结果:患者经化疗后MDA的含量增加、SOD降低、丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)明显升高,第5天时变化明显(P<0.05)。患者经乌司他丁治疗后,MDA在不同时段变化不明显,但与对照组同时段比较明显降低(P<0.01),而SOD变化不明显,ALT、AST、TBil比对照组明显降低(P<0.01);两组患者的CD3+、CD4+、CD4+/CD8+比值以及NK细胞活性均在化疗5 d后明显降低,7 d后回升,CD4+、CD4+/CD8+比值和NK细胞活性,治疗组与对照组同时段比较有显著性差异(P<0.05),而且治疗组波动幅度较小。结论:乌司他丁可能通过抑制化疗时机体内氧自由基的生成来保护肝功能,同时增强免疫功能。

Objective： To explore the effects of ulinastatin（UTI） on oxygen free radicals, liver function and immunity function during chemotherapy after resection of hepatocellular carcinoma. Methods： Fifty-five patients undergoing chemotherapy by portal vein infusion （PVI） and PVI ＋hepatic artery infusion （PVI ＋HAI） after resection of hepatocellular carcinoma were divided into UTI group （n=30, 15 cases of PVI, 15 cases of PVI＋HAI） and control group （n=25, 15 cases of PVI, 10 cases of PVI＋HAI）. In UTI group 2 × 10^5 units/day of UTI was continuously given through micropump drip for 7 days. Test for malondialdehyde （MDA） and superoxide dismutase （SOD） as well as immunity and liver function were performed before chemotherapy and at different time periods after chemotherapy. The control group did not use UTI. Results： The level of MDA in UTI group was significantly lower than that in control group （P〈0.01）, while there was no significant difference in level of SOD between UTI and control groups. The levels of alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and total billirubin （TBil） in UTI group were significantly lower than those in control group （P〈0.01）. The values of CD3^＋ , CD4^＋ , CD4^＋/CD8^＋ ratio and the activity of NK cells descended on the 5th day, and rose on the 7th day after chemotherapy in the two groups. There were statistically significant differences in values of CD4^＋ , CD4^＋/CD8^＋ and activity of NK cells between UTI and control groups （P〈0.05）. Conclusion： UTI can improve liver function through inhibiting the production of oxygen free radicals and also improve the immune function.