异甘草酸镁联合双环醇治疗原发性肝癌患者肝动脉化疗栓塞术后肝损伤的疗效观察

Observation on Efficacy of Magnesium Isoglycyrrhizinate Combined with Bicyclol in Treatment of Liver Injury After Transcatheter Arterial Chemoembolization in Patients with Primary Hepatic Carcinoma

目的:探讨预防性应用异甘草酸镁联合双环醇治疗原发性肝癌患者肝动脉化疗栓塞术(transcatheter arterial chemoembolization,TACE)后肝损伤的临床疗效。方法:回顾性选取2016年1月至2018年4月复旦大学附属中山医院收治的行TACE术的原发性肝癌患者197例作为研究对象,按照保肝药物的应用情况分为对照组68例、观察1组65例和观察2组64例。对照组患者仅使用还原性谷胱甘肽注射液,观察1组患者在对照组的基础上加用双环醇片,观察2组患者在对照组的基础上加用异甘草酸镁注射液和双环醇片。保肝药物均在TACE术当日给药,异甘草酸镁注射液用药时间≥3 d,双环醇片疗程≥4周。记录患者TACE术前后的生物化学指标水平,包括丙氨酸氨基转移酶(ALT)、天门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)、谷氨酰氨基转移酶(GGT)及总胆红素(TBIL)水平,比较三组患者肝功能改善情况的差异。结果:TACE术后第2日、出院前,三组患者ALT、AST及TBIL水平明显高于治疗前,差异均有极显著统计学意义(P<0.01)。下次TACE术前,观察2组患者的ALT水平明显低于治疗前和对照组同期,差异均有统计学意义(P<0.05);而对照组患者的AST、ALP及TBIL水平明显高于治疗前,差异均有统计学意义(P<0.05)。术后第2日、出院前,观察2组患者的TBIL水平明显低于对照组,差异均有统计学意义(P<0.05)。观察2组患者的总有效率为73.4%(47/64),明显高于对照组的47.1%(32/68),差异有统计学意义(P<0.05)。结论:异甘草酸镁联合双环醇对行TACE的原发性肝癌患者肝损伤有较好的保护作用,效果优于单用还原性谷胱甘肽。

OBJECTIVE: To probe into the clinical efficacy of magnesium isoglycyrrhizinate combined with bicyclol in treatment of liver injury after transcatheter arterial chemoembolization(TACE) in patients with primary hepatic carcinoma. METHODS: 197 patients with primary hepatic carcinoma undergoing TACE admitted into Zhongshan Hospital Affiliated to Fudan University from Jan. 2016 to Apr. 2018 were retrospectively selected and divided into control group(68 cases), observation group 1(65 cases) and observation group 2(64 cases) according to the application of liver-protecting drugs. The control group was treated with reduced glutathione injection, the observation group 1 was given Bicyclol tablets based on control group, the observation group 2 was given magnesium isoglycyrrhizinate injection combined with bicyclol tablets based on control group. All three groups were administrated on the day of TACE, the medication time of magnesium isoglycyrrhizinate injection was ≥3 days, and the course of bicyclol tablets was ≥4 weeks. The biochemical markers before and after TACE were recorded, including alanine aminotransferase(ALT), aspartate aminotransferase(AST), alkaline phosphatase(ALP), and glutamyl transferase(GGT) and total bilirubin(TBIL) levels, differences in improvements of liver function among three groups were compared. RESULTS: At the second day of TACE and before discharge, the ALT, AST and TBIL levels of three groups were significantly higher than those of before treatment, with extremely statistically significant differences(P<0.01). Before next TACE, the ALT level of observation group 2 was significantly lower than that of before treatment and the control group, with statistically significant differences(P<0.05);the AST, ALP and TBIL levels of control group were significantly higher than those of before treatment, with statistically significant differences(P<0.05);at the second day after operation and before discharge, the TBIL levels of observation group 2 were significantly lower than those of control group, with statistically significant differences(P<0.05). The total effective rate of observation group 2 was 73.4%(47/64), which was significantly higher than that of the control group(47.1%, 32/68), with statistically significant difference(P<0.05). CONCLUSION: Magnesium glycyrrhizinate combined with bicyclol has a better protective effect on liver injury in patients with primary hepatocellular carcinoma who undergoing TACE, which is better than that of reduced glutathione alone.