乳腺癌辅助化疗患者肝损伤的临床特点及相关因素分析

Clinical characteristics and related factors of liver injury in breast cancer patients treated with adjuvant chemotherapy

目的:总结乳腺癌辅助化疗患者发生化疗性肝损伤(CILI)的临床特点及相关影响因素。方法:选取2015年3月至2018年3月我院收治的乳腺癌辅助化疗患者549例,统计CILI的发生率及临床特点,研究相关因素对其的影响。结果:(1) 549例患者中肝损伤发生率为15.7%,其中肝损伤Ⅰ度69例,Ⅱ度15例,Ⅲ度2例。(2) CILI发生在第1周期14例,第2周期47例,第3周期23例,第4周期及以上2例。(3) CILI的发生与年龄、肿块大小、肿瘤类型、有无腋窝淋巴结转移、组织学分级、临床分期、骨髓抑制、乙肝病毒携带情况、有无高血压、有无糖尿病、体质指数、是否吸烟、是否饮酒无明显相关性(P>0.05),而高脂血症、肝转移、三联用药者更容易出现CILI(P<0.05)。结论:乳腺癌辅助化疗患者发生肝损伤以Ⅰ度为主,且发生率不高,容易发生在化疗第2周期。高脂血症、肝转移患者应尽量避免使用三联药物化疗。

Objective: To summarize the clinical features of chemotherapy-induced liver injury(CILI) in breast cancer patients,and to analyze its related influencing factors.Methods: Five hundred and forty-nine breast cancer patients admitted to our hospital and treated with adjuvant chemotherapy from March 2015 to March 2018 were selected.The incidence and clinical characteristics of CILI,and its related influencing factors were investigated and studied.Results:(1) The incidence of liver injury in 549 patients treated with adjuvant chemotherapy for breast cancer was 15.7%,including 69 cases of gradeⅠ,15 of grade Ⅱ and 2 of grade Ⅲ.(2) CILI occurred in 14 cases of the first cycle,47 of the second,23 of the third and in 2 cases of the fourth cycle and over.(3) The incidence of CILI was not significantly correlated with age,mass size,tumor type,axillary lymph node metastasis,histological grade,clinical stage,myelosuppression,hepatitis B virus carriers,hypertension,diabetes,body mass index,smoking and alcohol consumption(P>0.05).Patients with hyperlipidemia,liver metastasis and three-drug combination chemotherapy were more likely to develop CILI(P<0.05).Conclusion: Liver injury of grade I is mainly found in patients treated with adjuvant chemotherapy for breast cancer,its incidence is not high and is prone to occur in the second cycles of chemotherapy.Three-drug combination chemotherapy should not be conducted in patients with hyperlipidemia and liver metastases.