原发性大肝癌患者TACE后S-腺苷蛋氨酸的护肝作用

The clinical study on the liver-protection of S-adenosy-methionine in large hepatocellular carcinoma patients after TACE

目的探讨S-腺苷蛋氨酸对原发性大肝癌患者经肝动脉介入化疗栓塞(TACE)后急性肝功能损害的保护作用。方法回顾性分析自2003年5月-2007年10月我院收治的51例肝肿瘤患者进行术后护肝治疗,治疗组在TACE后静脉滴注S-腺苷蛋氨酸1000mg/d;对照组TACE后静脉滴注甘利欣30ml/d(含甘草酸二铵盐150mg)治疗。两组均在TACE术前第1天,术后第2、4、8天抽血查肝功能。结果肝功能各指标在TACE前后均发生明显变化,术后第2天ALT、AST、TBIL及DBIL均较术前不同程度的升高(P<0.05),术后第4天起各指标开始逐渐下降。治疗组总TACE前TBIL、DBIL、ALT和AST与术后第8天比较差异无统计学意义(P>0.05)。对照组ALT、AST及TBIL、DBIL在TACE术后第8天有显著升高(P<0.05)。总蛋白(TP)及白蛋白(A)TACE前与术后第8天比较无显著性差异(P>0.05)。治疗组中15例(60%)患者汉密顿抑郁量表总分出现下降。结论S-腺苷蛋氨酸对肝癌患者TACE治疗后有保护肝功能作用,近期保护急性肝损害疗效满意。S-腺苷蛋氨酸还具有一定的抗抑郁作用,可增加TACE的疗效,提高患者的生活质量。

Objective To study effects of S-adenosy-methionine （SAMe） for acute hepatic functional damage after transcatheter chemoembolization in the treatment of primary large HCC. Methods The clinical data of 51 cases of liver neoplasm after TACE from May 2003 to October 2005 were analyzed retrospectively, including SAMe 1000 mg intravenous drip after TACE daily of the treatment group and diammonium glyeyrrhizinate 30 ml intravenous drip after TACE daffy of the control group. The two groups were separately assessed the hepatic function on 1st day preoperatively and the 2nd, 4th d and 8th day, postoperatively, and together with the hamilton depression rating scale for derpression （HRSD）and the clinical general impression estimation for the evaluation of the clinical efficiency. Results All the hepatic functional labels changed markedly after TACE with ALT,AST,TBIL and DBIL rising to a certain extent on the 2nd day postoperatively （P 〈 0.05）. The labels began to decrease on the 4th day. There were no significant statistical differences of ALT,AST,TBIL and DBIL between 1st day preoperativly and 8th day postoperatively in the treatment group （P 〉 0.05）. There were significant differences of the labels during the same period in the control group （P 〈 0.05）. γ-GT changed irregularly in the two groups. There were also no significant differences of TP and A between 1st d preoperatively and 8th d, postoperatively in the two groups. In the treatment group, 15 patients （60%） showed relief of chief complaints of fatigue, hypodynamia, anxiety, insomnia. The total scores of HRSD also decreased revealing the better cooperation of the patients with treatment. Conclusions SAMe provides hepatic functional protection for large primary HCC patients after TACE especially for the satisfactory short-term efficiency in acute liver damage with simultaneous anti-depression and enhancing TACE effects, and promoting life quality.