肝癌TACE中化疗和栓塞与肿瘤抑制和肝损伤关系的临床研究

Effect of chemotherapeutics and embolization on tumor inhibition and liver injury in TACE treatment of hepatic carcinoma

目的研究肝癌TACE中化疗与栓塞的并用与否对肿瘤抑制和肝损伤的影响。方法回顾性分析152例HCC患者接受化疗灌注(A组30例)、栓塞(B组29例)或化疗栓塞(C组93例)后1天和4天,AFP下降及肝功能各指标变化。结果(1)AFP下降人数,B组(56.5%,78.3%)和C组(67%,80.7%)显著大于A组(25%,25%)(P<0.001)。(2)肝功能异常人数增幅表现为:TBil,A、C组明显高于B组(P<0.001)。ALT及ALB,B、C组明显大于A组(P<0.005)。PA,C组明显高于A、B组(P<0.005)。结论TACE对肿瘤的抑制主要归功于肿瘤供血血管的栓塞作用;加用肝动脉化疗灌注后,肝损伤的增加明显大于对肿瘤的抑制。

Objective To discuss the effect of chemotherapeutics and embolization on tumor inhibition and liver injury in TACE treatment of hepatic carcinoma. Methods AFP and liver function were investigated and evaluated in 152 HCC patients who had been treated by TAC （ group A, n = 30） or TAE （ group B, n = 29） or TACE （ group C, n = 93 ） without extra - liver metastasis. Results At the 1^st, d and 4^th d after TACE, （ 1 ） the rate of AFP decrease were higher in group B （56, 5% ,78. 3% ） and group C （67% ,80. 7% ） than that in group A （25% ,25% ）, P 〈0. 01. （2）the abnormal rate amplification, bilirubin total was higher in group A（ 119. 54% ,116. 1% ） and group C （ 157. 8% ,140% ） than that in group B （41.3% ,28% ） ,P 〈0. 001. ALT and ALB were higher both in group B and group C than that in group A, P 〈0. 005. Pre -albumin was higher in group C （ 17.5% ,114.4% ）than that in group A （3.3% ,0） and group B（3.5% ,29. 4%） ,P 〈0. 005. Conclusion It is chemoembolization that play an important role in tumor inhibitory action in TACE treatment. The increase of chemotherapeutics dosage accompanied exacerbation of liver injury. It suggested that the control of best combining site both increase tumor inhibitory action and decrease liver injury is key point to evaluate therapeutic effect of TACE.