恶性肿瘤患者免疫治疗期间发生肝不良事件的相关影响因素

Analysis of Related Factors Affecting Liver Adverse Events in Immunotherapy of Patients with Malignant Tumors

目的 探讨恶性肿瘤患者免疫治疗期间发生肝不良事件的相关影响因素。方法 回顾性分析154例恶性肿瘤患者临床资料,所有患者均采用免疫治疗,记录治疗3个月期间肝不良事件发生情况。根据患者肝不良事件发生情况分为发生组与未发生组,统计2组一般资料,包括性别、年龄、有无HBV感染、合并慢性疾病、是否使用保肝药物、吸烟史、既往有无肝损伤史、是否发生肝转移,分析恶性肿瘤患者免疫治疗期间发生肝不良事件的相关影响因素。结果 154例恶性肿瘤患者中,免疫治疗期间有32例发生肝不良事件,发生率为20.78%(32/154)。发生组感染HBV、未使用保肝药物、既往有肝损伤史、发生肝转移占比均高于未发生组,差异有统计学意义(P<0.05);2组性别、年龄、是否合并慢性疾病、吸烟史对比,差异无统计学意义(P>0.05);Logistic回归分析:感染HBV、未使用保肝药物、既往有肝损伤史、发生肝转移是恶性肿瘤患者免疫治疗期间发生肝不良事件的独立危险因素(P<0.05且OR≥1)。结论 恶性肿瘤患者免疫治疗期间易发生肝不良事件,感染HBV、未使用保肝药物、既往有肝损伤史、发生肝转移是其独立危险因素,临床需予以高度重视。

Objective To explore the influencing factors of liver adverse events in patients with malignant tumors.Methods The clinical data of 154 malignant tumor patients were retrospectively analyzed,and all patients underwent immunotherapy and recorded the occurrence of the adverse liver events during the 3 months of treatment.According to the occurrence of liver adverse events,patients were divided into occurrence and untreated groups.General data were counted,including gender,age,HBV infection,chronic diseases,use of liver-preserving drugs,smoking history,previous history of liver injury,and whether liver metastasis occurred.The influencing factors of developing adverse liver events in malignant patients were analyzed.Results Of the 154 patients with malignant tumors,32 adverse hepatic events occurred during the immunotherapy period,The incidence rate was 20.78%(32/154);HBV infection,no liver-preserving drugs,a previous history of liver injury,and the proportion of liver metastasis were all higher than those in the untreated group,The difference was statistical significant(P<0.05);Comparison of gender,age,whether combined chronic disease and smoking history between the 2 groups,The difference was not significantly significant(P>0.05);Logistic regression analysis:HBV infection,no use of liver-preserving drugs,a previous history of liver injury,and liver metastasis were independent risk factors for developing adverse liver events in the immunotherapy of patients with malignant tumors(P<0.05 and OR 1).Conclusion Immunotherapy in patients with malignant tumors is prone to liver adverse liver events,and HBV infection,no liver protective drugs,previous liver injury and liver metastasis are their independent risk factors,which should pay great attention to clinical treatment.