乳腺癌患者化疗后肝功能异常的危险因素分析

Analysis of Risk Factors for Abnormal Liver Function in Breast Cancer Patients After Chemotherapy

目的筛选乳腺癌患者化疗后肝功能异常的危险因素。方法回顾性收集2016年7月至2022年11月锦州医科大学附属第一医院肿瘤中心7个病区收治的乳腺癌化疗患者416例,记录患者的一般资料、基线血常规、基线生化指标、及化疗后肝功能异常指标,分析化疗后肝功能异常的发生率、严重程度及出现时间,应用Logistic回归分析筛选化疗后肝功能异常的危险因素。结果416例患者中有55.5%(281/416)出现肝功能异常,其中1级193例(83.5%),2级28例(12.1%),3级10例(4.3%)。首次发生肝功能异常的中位时间为29 d,中位周期为第2周期。单因素Logistic分析显示肝功能异常与年龄、高血压、伴随用药、BMI、空腹血糖异常、基线肝功能ALT、基线肝功能AST、基线肝功能TBil、基线血红蛋白相关;多因素Logistic回归分析显示BMI,基线肝功能ALT是化疗后肝功能异常的独立危险因素(P<0.05),ROC曲线确定的BMI截断值为22.21,基线肝功能ALT的截断值为17.5 U/L。结论BMI≥22.21、基线肝功能ALT≥17.5 U/L可能使化疗后肝功能异常的发生风险增加,此类患者化疗期间应密切监测肝功能。

Objective To screen the risk factors of abnormal liver function in breast cancer patients after chemotherapy.Methods Medical records of 416 breast cancer chemotherapy patients admitted to 7 wards of Cancer Center of the First Affiliated Hospital of Jinzhou Medical University from July 2016 to November 2022 were retrospectively collected.General data,baseline blood routine,baseline biochemical indexes,and indicators of abnormal liver function after chemotherapy were recorded.The incidence,severity and time of abnormal liver function after chemotherapy were analyzed.The risk factors of abnormal liver function after chemotherapy were screened by Logistic regression analysis.Results Of the 416 patients,55.5%(281/416)had abnormal liver function,including 193(83.5%)in grade 1,28(12.1%)in grade 2,and 10(4.3%)in grade 3.The median time for first onset of abnormal liver function was 29 days,and the median cycle was the second cycle.Univariate Logistic analysis showed that abnormal liver function was correlated with age,hypertension,concomitant medication,BMI,abnormal fasting blood glucose,baseline liver function ALT,baseline liver function AST,baseline liver function TBil and baseline hemoglobin;multivariate Logistic regression analysis showed that BMI and baseline liver function ALT were independent risk factors for liver function abnormalities after chemotherapy(P<0.05).The cut-off value of BMI determined by ROC curve was 22.21,and the cut-off value of baseline liver function ALT was 17.5 U/L.Conclusion BMI≥22.21 and baseline liver function ALT≥17.5 U/L may increase the risk of abnormal liver function after chemotherapy,and liver function should be closely monitored during chemotherapy in these patients.