比较同步放化疗和单纯化疗对胃肠道肿瘤并HBV携带者肝脏损害的影响

Concurrent Chemoradiotherapy versus Chemotherapy Alone in Liver Damage in HBV Carriers with Gastroesophageal Adenocarcinoma

目的∶探讨携带乙型肝炎病毒(hpmitis B vim,HBV)的胃肠道肿瘤患者在分别接受同步放化疗及单纯化疗的过程中出现肝功能损害及病毒激活的影响。方法∶选取2014年10月至2017年10月在我院肿瘤中心就诊的88例携带HBV的胃肠道肿瘤术后患者,其中胃癌44例,结直肠癌44例,分期为Ⅲ~Ⅳ期。接受同步放化疗的患者29例,接受单纯化疗的患者59例。回顾性分析胃肠道肿瘤患者接受同步放化疗及单纯化疗过程中肝功能损害情况及与肝功能损害相关的危险因素,采用χ^2检验、Logistic回归等方法,研究放化疗对肝脏损伤和HBV激活发生率的影响。结果;在8例患者中,总共25例患者在接受治疗后出现肝功能损害,同步放化疗的肝损伤发生率为55.20%,单纯化疗的肝损伤发生率为15.30%。其中同步放化疗中肝损害∶Ⅰ度肝损伤5例(17.20%),Ⅰ度肝损伤5例(17.20%),Ⅲ度肝损伤4例(13.80%),Ⅳ度肝损伤2例(6.90%);单纯化疗中肝损害∶Ⅰ度肝损伤8例(13.60%),Ⅱ度肝损伤1例(1.7%)。29例同步放化疗的患者中5例出现HBV激活(17.20%),59例单纯化疗的患者中3例出现HBV激活(5.10%),两者比较差异无统计意义(P=0.062)。结论∶胃肠道肿瘤患者接受同步放化疗后出现肝损伤的风险明显高于接受单纯化疗患者,且单纯化疗的肝损伤多为轻度损伤;肝损伤发生率与同步放化疗、化疗周期及肝脏耐受量相关。

Objective:To compare coneurrent chemordiotherapy or chemotherapy alone induced liver damage in gastroe-sophageal adenoearcinoma patients camying hepatitis B virus(HBV).Methods:We reriewed data of 88 gastresophageal adenocarcinoma putients(44 gastric cancer ptients vs 44 colon cancer putients,stageⅢ-Ⅳ)who had HBV and received treatment in the Second People's Hospital of Neiiang between Oetober 2010 and October 2014.29 received concurent chemoradiotherapy,and 59 rceived ruadiothrapy.Risk factors of hepatic dyfunction were rtospectively analyzed in gatrointestinal lumors patients received concurrent chemoradiotherapy and chemotherapy alone.Chisquare test and logisitie regression were used to investgate the ffects of two therapies on incidences of liver injury and HBV activation.Results:In 88 patients,25 developed impaired liver function after treatment.In putients treated by concurrent chermorndiothrapy,the incidence of liver injury[5 cases in grade Ⅰ(17.20%),5 casts in gradeⅡ(17.20%),4 cases in gradeⅢ(13.80%),and 2 eases in gradeⅣ(6.90%)]was 55.20%;while the incidence of liver injury[8 ceases in grade Ⅰ(13.60%)and 1 case in gradeⅡ(1.70%)]in patients treated by radiothrapy alone was 15.30%,Activation of HBV was rcorded in 5 patients(17.20%)treated by concurent chenoradiotherapy;it was observed in 3 patients(5.10%)treated by chemnotherapy a lone;and there was no signifcant dffrence between the two groups(P=0.062).Conelusion:Castroesophageal adenocarcinoma patients with HBV are more likely to suffer from liver damage after concurent chemoradiotherapy than chemotherapy alone.The incidence of liver injury is related to concurrent chemoradiotherapy,cycles of chemotherapy and liver tolerance.