复方甘草酸苷防治原发性肝癌三维适形放疗后肝损伤的临床观察

doi:10.3969/j.issn.1672-5069.2012.05.0017

摘要/Abstract

摘要： 目的探讨复方甘草酸苷在防治原发性肝癌（PLC）三维适形放疗（3DCRT）后肝损伤的作用。方法 113例PLC患者被随机分为治疗组62例和对照组51例,两组均采用3DCRT治疗,分割剂量为2.6~3.2Gy/次,总剂量为48~60Gy;治疗组同时给予复方甘草酸苷注射液60~100 ml/日,静脉滴注,疗程4周,再改为片剂口服,共2~3个月。结果两组患者放疗后ALT和AST较放疗前均有所升高,但治疗组ALT （51.6±12.6 U/L）和 AST （48.3±14.4 U/L）升高程度明显低于对照组（分别为85.2±19.9 U/L和73.8±17.8 U/L,P<0.01）;治疗组发生放射性肝病（RILD）4例（6.5%）,而对照组发生10例（19.6%）,治疗组明显低于对照组（P<0.05）。结论复方甘草酸苷能预防和改善PLC患者在3DCRT治疗后的肝损伤,降低RILD的发生率。

关键词: 肝细胞癌, 三维适形放疗, 放射性肝损伤, 复方甘草酸苷

Abstract: Objective To investigate the protective effects of compound glycyrrhizin on hepatic injury induced by three-dimensional conformal radiotherapy（3DCRT） in patients with primary liver carcinoma（PLC）. Methods A total of 113 patients with advanced hepatocellular carcinoma were randomly divided into study group （n=62） and control group （n=51）. The patients in the two groups were treated with 3DCRT,and the dose was 2.6~3.2Gy each time with the total doses of 48~60Gy;and the patients in study group were also treated with injections of compound glycyrrhizin intravenously at dose of 60ml per day for 4 weeks,then the glycyrrhizin tablets were given orally for 2~3 months. Results The levels of ALT and AST after radiation in both groups were elevated as compared with that before radiation, but the elevated levels of ALT （51.6±12.6 U/L） and AST（48.3±14.4 U/L） in the study group were significantly lower than that in the control group（85.2±19.9 U/L and 73.8±17.8 U/L,respectively,P<0.01）,and the rate of radiation-induced liver disease（RILD） in the study group（4 cases,6.5%） was lower than that in the control group（10 cases,19.6%,P<0.05）. Conclusion Compound glycyrrhizin can prevent and improve the hepatic injury induced by 3DCRT in patients with PLC, and it also can reduce the rate of RILD occurrence.

Key words: Hepatoma, Hepatic injury, Three-dimensional conformal radiotherapy, Radiation-induced liver disease, Compound glycyrrhizin

谭新劲, 任丽, 白光洪. 复方甘草酸苷防治原发性肝癌三维适形放疗后肝损伤的临床观察[J]. 实用肝脏病杂志, 2012, 15(5): 424-426.

Tan Xinjin, Ren Li, Bai Guanghong.. Protective effects of compound glycyrrhizin on hepatic injury induced by three-dimensional conformal radiotherapy in patients with primary liver carcinoma[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2012, 15(5): 424-426.

参考文献

[1] Liang SX,Zhu XD,Xu ZY,et al. Radiation-induced liver disease in three dimensional conformal radiation therapy for primary liver carcinoma: the risk factors and hepatic radiation tolerance. Int J Radiat Oncol Phys,2006,65（2）:426-434.
[2] 杨秉辉,夏景林. 原发性肝癌的临床诊断与分期标准. 中华肝脏病杂志,2001,19（6）:324.
[3] Lawrence TS,Ten Haken RK,Kessler ML,et al. The use of 3-D dose volume analysis to predict radiation hepatitis. Int J Radiat Oncol Biol Phys,1992,23（4）:781-788.
[4] Trotti A,Byhardt R,Stetz J,et al. Common toxicity criteria: version 2.0. An improved reference for grading the acute effects of cancer treatment:impact on radiotherapy. Int J Radiat Oncol Biol Phys,2000,47（1）:13-47.
[5] Sempoux C,Horsmans Y,Geubel A,et al. Severe radiation-induced live disease following localized radiation therapy for biliopancreatic carcinoma: activation of hepatic stellate cells as an early event. Hepatology,1997,26（1）:128-134.
[6] Dawson LA,Ten Haken RK,Lawrence TS. Partial irradiation of the liver. Semin Radiat Oncol,2001,11（3）:240-246.
[7] 梁世雄,蒋国梁,朱小东,等. 原发性肝癌三维适形放疗后放射性肝病的影响因素. 中华放射肿瘤学杂志,2005,14（4）:284-288.
[8] 赵增虎,刘俊堂,范青建. 放射性肝损伤研究及防治进展. 现代肿瘤医学,2011,19（10）：2110-2113.
[9] Liang SX,Zhu XD,Lu HJ,et al. Hypofractionated three-dimensional conformal radiation therapy for primary live carcinoma. Cancer,2005,103（10）:2181-2188.
[10] 宋方闻. 白永敏. 陈玉祥,等. 美能（β体-甘草酸复方制剂）的分子构型及临床疗效.中国药房,2003,14（5）:304-305.
[11] 于泽.复方甘草酸苷在肿瘤放化疗保护领域的研究进展. 中国药房,2005,16（23）：1830-1832.
[12] 马磊,赵旭,林姬英,等. 复方甘草酸苷在胃肠道肿瘤化疗中改善毒副作用的临床观察. 实用肝脏病杂志,2008,11（1）：38-39.
[13] 金璋,陈增边,曹辉,等. 复方甘草酸苷注射液治疗放射性肝病的临床研究. 中国临床药理学杂志,2010,26（3）:183-185.
[14] Seong J,Park HC,Han KH,et al. Clinical results and prognostic factors in radiotherapy for unresectable hepatocellular carcinoma: A retrospective study of 158 patients. Int J Radiat Oncol Biol Phys,2003,55（2）:329-336.

[1]	朱娅鸽, 刘锦峰. 丁二磺酸腺苷蛋氨酸联合复方甘草酸苷治疗酒精性肝硬化患者疗效及其对血清BGP水平的影响^*[J]. 实用肝脏病杂志, 2019, 22(6): 872-875.
[2]	曹策, 郁义星, 王贝贝, 赵卫峰. 增强磁共振成像联合血清甲胎蛋白和脱-γ-羧基凝血酶原诊断肝细胞癌临床价值探讨[J]. 实用肝脏病杂志, 2019, 22(6): 896-899.
[3]	朱俊, 丁莹, 王世清, 张野, 刘野, 刘泽刚. 围手术期应用乌司他丁治疗对肝细胞癌患者肝切除术后外周血Th22细胞百分比和血浆白细胞介素-22的影响*[J]. 实用肝脏病杂志, 2019, 22(5): 720-723.
[4]	王刚, 赵洪波, 朱亚玲, 蒋保三, 张越美, 刁勇. 基于数据库分析肝细胞癌细胞XPO5基因水平变化及其临床意义*[J]. 实用肝脏病杂志, 2019, 22(5): 724-727.
[5]	戴青云, 王润东, 荚卫东. 术前预后营养指数评估肝细胞癌患者肝切除术后早期肿瘤复发价值探讨^*[J]. 实用肝脏病杂志, 2019, 22(4): 561-564.
[6]	杨富存, 尚怀学, 盖永浩. 钆塞酸二钠增强磁共振扫描诊断肝脏局灶性病变研究^*[J]. 实用肝脏病杂志, 2019, 22(4): 577-580.
[7]	彭新健, 肖玉辉, 许斯鼎, 石荣跃, 王耀政, 王瑜琳. 放射性肝损伤患者肝脏磁共振扩散加权成像表现特征分析[J]. 实用肝脏病杂志, 2019, 22(3): 373-376.
[8]	乔志忠. 超声造影定量分析鉴别肝脏局灶性结节性增生与原发性肝癌初步探讨[J]. 实用肝脏病杂志, 2019, 22(3): 421-424.
[9]	朱光曦（综述）, 文良志, 陈东风（审校）. 非酒精性脂肪性肝病相关肝细胞癌发病机制研究进展[J]. 实用肝脏病杂志, 2019, 22(3): 453-456.
[10]	王虎明,樊东升,徐杰,刘险峰,周宁,丽敏,包娜娜. 肝细胞癌患者癌组织miRNA-30c水平变化及其临床意义探讨^*[J]. 实用肝脏病杂志, 2019, 22(2): 248-251.
[11]	幸奠奎,程婧. ¹⁸F-FDG PET/CT检查指标预测肝细胞癌微血管侵犯临床价值研究^*[J]. 实用肝脏病杂志, 2019, 22(2): 252-254.
[12]	王秀清,马艳君,詹晋莉. 肝动脉化疗栓塞术联合超声引导下微波消融术治疗特殊部位原发性肝癌患者疗效及安全性分析 ^*[J]. 实用肝脏病杂志, 2019, 22(2): 260-263.
[13]	张小舟,帅领,王庆大,杨楠. 接受TACE治疗的肝细胞癌患者血清miR-335水平变化及其对预后判断的价值分析^*[J]. 实用肝脏病杂志, 2019, 22(2): 268-271.
[14]	王朝霞,关珂,付三仙,王慧杰. 肠内肠外联合营养支持治疗肝细胞癌患者围术期临床研究^*[J]. 实用肝脏病杂志, 2019, 22(2): 272-275.
[15]	赵西太综述,聂青和审校. 循环microRNA早期诊断肝细胞癌研究现状及方法学探讨[J]. 实用肝脏病杂志, 2019, 22(2): 297-300.