蒽环类药物化疗导致乳腺癌术后患者发生药物性肝损伤临床特征分析*

doi:10.3969/j.issn.1672-5069.2025.02.015

摘要/Abstract

摘要： 目的探讨蒽环类药物化学治疗乳腺癌术后患者引起药物性肝损伤(DILI)的临床特征。方法 2020年5月～2023年5月我院诊治的I期/ II期乳腺癌术后患者155例,均接受蒽环类药物化疗,观察DILI发生和临床分型情况,并给予降酶或/和退黄处理。结果本组乳腺癌患者在接受蒽环类药物治疗过程中,发生DILI 92例(59.4%),其中肝细胞损伤型57例,胆汁淤积型25例和混合型10例;DILI组患者年龄为(45.6±7.2)岁,显著大于未发生DILI组【(40.5±8.5)岁,P<0.05】,体质指数为(26.2±2.2)kg/m²,显著大于未发生DILI组【(23.0±2.4)kg/m²,P<0.05】,合并高血压、糖尿病、高脂血症和II期肿瘤占比分别为25.0%、17.4%、18.5%和52.2%,显著高于未发生DILI组的6.3%、4.8%、4.8%和31.7%(P<0.05);在DILI发生后,经调整抗肿瘤治疗方案及给予甘草酸类降酶和熊去氧胆酸退黄处理,各型DILI患者血生化指标均得以恢复,继续接受后续化疗治疗和随访。结论接受蒽环类药物化疗的乳腺癌术后患者发生DILI比较常见,但经积极护肝处理,预后良好,需要及时监测。

关键词: 药物性肝损伤, 乳腺癌, 蒽环类药物, 临床特征

Abstract: Objective This study was to summarize the clinical features of drug-induced liver injury (DILI) in patients with breast cancer during anthracycline chemotherapy. Methods A total of 155 patients with stage I/ IIbreast cancer after operation were encountered in our hospital between May 2020 and May 2023, and all received anthracycline chemotherapy. The clinicians maintained carefully surveillance on DILI, and the anti-tumor regimen was adjusted and the liver-protecting medicines were given in time according to the clinical types of DILI. Results During chemotherapy, the DILI was found in 92 cases (59.4%) out of our series, with the hepatocyte injury in 57 cases, the cholestasis in 25 cases and the mixed type in 10 cases; the age in patients with DILI was (45.6±7.2)yr, significantly older than [(40.5±8.5)yr, P<0.05], the body mass index was (26.2±2.2)kg/m², much greater than [(23.0±2.4)kg/m², P<0.05], and the incidences of concomitant hypertension, diabetes, hyperlipidemia and stage II tumor were 25.0%, 17.4%, 18.5% and 52.2%, all significantly higher than 6.3%, 4.8%, 4.8% and 31.7%, respectively(P<0.05)in patients without DILI; the chemotherapy was adjusted and the glycyrrhizic acid and/or ursodeoxycholic acid were given in patients with DILI, and the prognosis was promising. All patients went on chemotherapy thereafter. Conclusion The DILI occurs common in patients with breast cancer during anthracyclinechemotherapy period, and careful surveillance and appropriate management might obtain a good outcomes.

Key words: Drug-induced liver injury, Breast cancer, Anthracycline, Clinical feature

范丹丹, 刘灵, 赵暖暖. 蒽环类药物化疗导致乳腺癌术后患者发生药物性肝损伤临床特征分析^*[J]. 实用肝脏病杂志, 2025, 28(2): 218-221.

Fan Dandan, Liu Ling, Zhao Nuannuan. Good prognosis of drug-induced liver injury in patients with breast cancer during anthracycline chemotherapy[J]. Journal of Practical Hepatology, 2025, 28(2): 218-221.

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蒽环类药物化疗导致乳腺癌术后患者发生药物性肝损伤临床特征分析^*

Good prognosis of drug-induced liver injury in patients with breast cancer during anthracycline chemotherapy

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