异甘草酸镁联合还原型谷胱甘肽预防骨肉瘤患者使用大剂量甲氨蝶呤所致肝损伤的临床疗效观察

Clinical Efficacy of Magnesium Isoglycyrrhizate Combined with Reduced Glutathione in Preventing Liver Injury of Osteosarcoma Patients Induced by High Dose Methotrexate

目的探讨异甘草酸镁联合还原型谷胱甘肽对骨肉瘤患者使用大剂量甲氨蝶呤(HD-MTX)所致肝损伤的预防作用。方法回顾性分析2018年7月—2019年6月我院收治的首次接受HD-MTX治疗的骨肉瘤患者的病例资料,按是否预防性使用异甘草酸镁和还原型谷胱甘肽将患者分为观察组和对照组,分析比较两组患者的肝损伤情况;通过单因素和多因素分析,研究预防性使用保肝药物对肝损伤的影响。结果研究共纳入71例患者,其中观察组37例,对照组34例,两组患者的肝损伤率分别为94.59%和100.00%(P>0.05);两组患者各级肝损伤分布情况比较,差异均无统计学意义(P>0.05);多因素分析结果显示,预防使用保肝药物仅能轻微降低ALT等级(β:-0.55,95%CI:-1.08^-0.02,P=0.043),对AST和TBIL等级无明显影响(P>0.05)。结论预防性使用异甘草酸镁联合还原型谷胱甘肽,可轻微降低骨肉瘤患者使用HD-MTX治疗导致的ALT升高,但尚不能确认其可预防药物性肝损伤。

Objective To explore preventive effect of magnesium isoglycyrrhizate combined with reduced glutathione on liver injury caused by high dose methotrexate(HD-MTX)in patients with osteosarcoma.Methods The data of patients with osteosarcoma who received HD-MTX for the first time between July 2018 and June 2019 were retrospectively analyzed.Patients were divided into observation group and control group according to the preventive treatment with magnesium isoglycyrrhizate and glutathione.The liver injury was analyzed and compared between the two groups.The effect of prophylactics on liver injury was calculated by single factor and multiple factor analysis.Results A total of 71 patients were enrolled in the study,37 in the observation group and 34 in the control group.The rates of liver injury cases were 94.59%and 100%respectively in the two groups(P>0.05).There was no significant difference in the distribution of liver injury grade between the observation group and control group(P>0.05).The results of multivariate analysis showed that prophylactic use of hepatoprotective drugs only slightly reduced the ALT levels(β:-0.55,95%CI:-1.08^-0.02,P=0.043)and had no effect on AST levels or TBIL levels(P>0.05).Conclusion Prophylactic administration of magnesium isoglycyrrhizate combined with reduced glutathione can slightly reduce ALT elevation in patients with osteosarcoma treated with HD-MTX.However,it cannot be confirmed that magnesium isoglycyrrhizate combined with reduced glutathione could prevent drug-induced liver injury.