CAJ | 학술논문

目的观察乙型肝炎病毒(HBV)标志物阳性与恶性肿瘤患者化疗后肝损害的关系,探讨其临床意义.方法回顾性分析2005年1月至2012年1月913例接受化疗的恶性肿瘤患者的临床资料,其中HBV阳性组288例,HBV阴性组625例,比较两组患者化疗后肝功能的变化情况.结果 HBV阳性组288例中有69例出现化疗后肝功能异常,占24.0％ (69/288),HBV阴性组625例中有71例出现化疗后肝功能异常,占11.4％(71/625),两组肝功能异常发生率比较差异有统计学意义(P＜0.01).在123例HBV-DNA阳性患者中,有14例患者化疗后出现Ⅲ～Ⅳ度肝损害,发生率11.4％(14/123).而在HBV阴性组中,仅4例(0.6％,4/625)发生Ⅲ～Ⅳ度肝损害.在各种化疗方案中,TP(紫杉醇+顺铂)、CAF(环磷酰胺+多柔比星+氟尿嘧啶)、CHOP(环磷酰胺+多柔比星+长春新碱+泼尼松)方案两组肝功能异常发生率比较差异有统计学意义(P＜0.05).以TP方案引起肝功能异常发生率最高,HBV阳性组为34.6％ (18/52),HBV阴性组为16.5％ (20/121).结论 HBV阳性的恶性肿瘤患者,尤其是HBV-DNA阳性者,化疗后更易发生肝损害.
목적 관찰을형간염병독(HBV)표지물양성여악성종류환자화료후간손해적관계,탐토기림상의의.방법 회고성분석2005년1월지2012년1월913례접수화료적악성종류환자적림상자료,기중HBV양성조288례,HBV음성조625례,비교량조환자화료후간공능적변화정황.결과 HBV양성조288례중유69례출현화료후간공능이상,점24.0％ (69/288),HBV음성조625례중유71례출현화료후간공능이상,점11.4％(71/625),량조간공능이상발생솔비교차이유통계학의의(P＜0.01).재123례HBV-DNA양성환자중,유14례환자화료후출현Ⅲ～Ⅳ도간손해,발생솔11.4％(14/123).이재HBV음성조중,부4례(0.6％,4/625)발생Ⅲ～Ⅳ도간손해.재각충화료방안중,TP(자삼순+순박)、CAF(배린선알+다유비성+불뇨밀정)、CHOP(배린선알+다유비성+장춘신감+발니송)방안량조간공능이상발생솔비교차이유통계학의의(P＜0.05).이TP방안인기간공능이상발생솔최고,HBV양성조위34.6％ (18/52),HBV음성조위16.5％ (20/121).결론 HBV양성적악성종류환자,우기시HBV-DNA양성자,화료후경역발생간손해.
Objective To evaluate the liver damage induced by chemotherapy in patients with cancer and positive for hepatitis B virus (HBV) markers.Methods From January 2005 to January 2012,913 cancer patients were treated by chemotherapy including HBV-positive patients (HBV-positive group,288 cases) and HBV-negative patients (HBV-negative group,625 cases).The changes of hepatic function after chemotherapy between two groups were compared.Results The incidence of hepatic toxicity in HBV-positive group was higher than that in HBV-negative group [24.0％ (69/288) vs.11.4％ (71/625)],and there was significant difference between two groups (P＜ 0.01).The incidence of degree 11Ⅲ-Ⅳ hepatic toxicity was 11.4％ (14/123) in HBV-DNA-positive patients and 0.6％ (4/625) in HBV-negative group.In a variety of chemotherapy,there was significant difference in the incidence of hepatic toxicity in TP(paclitaxel +cisplatin),CAF(cyclophosphamide + doxorubicin + fluorouracil),CHOP(cyclophosphamide + doxorubicin +vincristine + prednisone) between two groups (P ＜ 0.05).The incidence of hepatic toxicity was highest in TP,which was 34.6％ (18/52) in HBV-positive group and 16.5％ (20/121) in HBV-negative group.Conclusion HBV infection is associated with higher risk of hepatic toxicity in patients with cancer during chemotherapy.