结直肠癌化疗所致肝损伤的影响因素及保肝药的合理性研究

Analysis of Factors Influencing Liver Injury Caused by Chemotherapy for Colorectal Cancer and Evaluation of Rationality of Liver-protecting Drugs

目的调查笔者所在医院结直肠恶性肿瘤患者化疗后肝损伤情况及保肝药的使用情况,分析可能影响肝损伤的有关因素,并评价不同化疗方案所致肝损伤的特点及使用保肝药的规范性。方法对笔者所在医院2017年6月1日—2018年5月31日期间接受化疗的200例结直肠癌患者用药情况进行回顾性分析,记录患者的个人信息、化疗方案及使用保肝药的情况,分析相关因素并评价保肝药使用合理性。结果从性别、年龄、体表面积、肿瘤类型、肿瘤分期、疗程、是否饮酒、化疗中出现的不良反应来分析与肝损伤可能有关的因素,发现肿瘤分期、疗程、化疗中出现中重度消化道反应与肝损伤有一定联系。从给药指征、重复给药、给药时机、疗程及用药禁忌等方面综合评价保肝药合理性,155例使用过保肝药的患者中,140例应用保肝药与说明书或指南推荐用法相符。结论不同化疗方案的肝损伤程度之间的差异无统计学意义,肿瘤分期和化疗疗程是肝损伤的影响因素。此外临床医师应更加规范的使用保肝药。

OBJECTIVE To investigate the status of liver injury and the use of hepatoprotective drugs in patients with colorectal malignant tumors,analyze the related factors that may affect liver injury,evaluate the characteristics of liver injury caused by different chemotherapy regimens and the normative use of hepatoprotective drugs.METHODS A retrospective analysis was performed on 200 patients with colorectal cancer who received chemotherapy during the period from June 1,2017 to May 31,2018.The patient's personal information,chemotherapy regimen,and use of hepatoprotective drugs were recorded.Analyze the relevant factors and evaluate the rationality of the use of liver-protecting drugs.RESULTS Factors related to liver injury were analyzed by gender,age,body surface area,tumor type,tumor stage,course of treatment,alcohol consumption,and adverse reactions in chemotherapy.It was found that tumor staging,period of treatment and moderate to severe gastrointestinal reactions in chemotherapy were associated with liver injury.The rationality of hepatoprotective drugs was evaluated comprehensively from the following aspects:indications of administration,repeated administration,timing of administration,course of treatment and contraindications of administration.The 140 of 155 patients who had used hepatoprotective drugs were in accordance with the instructions or guidelines for the use of hepatoprotective drugs.CONCLUSION There is no significant difference in the degree of liver injury between different chemotherapy regimens.Tumor staging and period of treatment are the influencing factors of liver injury.In addition,the use of hepatoprotective drugs should be more standardized in clinic.