铂类化疗药应用于持续腹腔热灌注治疗时的肾毒性评价

The evaluation of cisplatin-induced nephrotoxicity throughhyper thermic intraperitoneal chemotherapy

目的了解顺铂等铂类药物应用于胃肠道肿瘤腹腔热灌注后短期肾毒性的发生情况。方法从我科消化道肿瘤数据库中选择2012年1月至2013年7月期间行持续腹腔热灌注治疗的患者作为研究对象,根据治疗过程灌注液是否使用铂类药物分为观察组(铂类组)与对照组(无铂类组),观察两组患者治疗结束前后肾功能变化、疼痛评分、血清白蛋白水平及住院日。结果 99例患者纳入分析,47例接受铂类腹腔灌注治疗。铂类治疗组灌注后血尿素氮、肌酐水平明显升高,且显著高于对照组(P<0.05)。4例患者出现急性肾损害,6例出现轻微肾功能不全,肾毒性发生率为21.3%。两组患者术后疼痛评分、白蛋白水平及住院日无显著性差异。结论腹腔持续热灌注联合铂类治疗可能增加急性肾损害风险。

Objective To investigate the incidence of cisplatin-induced nephrotoxicity through hyper thermic intraperitoneal chemotherapy(HIPEC) for gastrointestinal tumors. Methods From January2012 to July 2013, a consecutive series of 99 patients undergoing HIPEC were retrospectively reviewed. The patients were divided into cisplatin group and non-cisplatin group, and received HIPEC combined with cisplatin or not. Renal function parameters, nutritional status and immune function were compared between the two groups. Results Based on the RIFLE classification, four patients developed acute kidney injury and 6 slight renal insufficiency in the cisplatin group, and no patients had renal failure. The incidence of cisplatin-induced nephrotoxicity was 21.3%. The BUN and creatinine levels significantly increased after perfusion therapy in the cisplatin group, were significantly higher than those in the non-cisplatin group..However, there were no significant differences in postoperative pain scaled with VAS score, albumin level and hospital stay between the two groups. Conclusion Cisplatin-based HIPEC could increase the risk of postoperative nephrotoxicity. Renal function should be strictly monitoredduring cisplatin-based chemotherapy.