应用还原型谷胱甘肽预防处理接受TACE治疗的中晚期原发性肝癌患者对肝功能的影响

doi:10.3969/j.issn.1672-5069.2019.03.029

摘要/Abstract

摘要： 目的探讨应用还原型谷胱甘肽（GSH）预防处理接受经肝动脉栓塞化疗（TACE）治疗的中晚期原发性肝癌（PLC）患者对肝功能的影响。方法 2010年2月~2014年7月我院收治138例PLC患者,被随机分为观察组71例和对照组67例,均接受TACE治疗,观察组在TACE术后加用GSH治疗7 d。结果在治疗后3 m复查CT评估近期疗效,结果观察组部分缓解和疾病稳定率分别为23.9%和60.6%,与对照组的20.9%和58.2%比,无显著性差异（P>0.05）;在治疗后10 d复查,观察组血清ALT和AST水平分别为（75.4±18.9） U/L和（101.6±18.4）U/L,显著低于对照组【（98.6±20.4） U/L和（121.2±30.4） U/L,P<0.05】;在治疗后2 w观察,观察组胃肠反应、白细胞减少、血红蛋白减少和血小板减少发生率分别为26.8%、22.5%、19.7%和2.8%,而对照组则分别为32.8%（P<0.05）、28.4%、29.9%（P<0.05）和6.0%;观察组和对照组患者6 m生存率分别为91.5%（65/71）和85.1%（57/67）,差异无统计学意义（P>0.05）,1 a生存率分别为84.5%（60/71）和61.2%（41/67）,差异有统计学意义（P<0.05）。结论应用还原型谷胱甘肽预防处理接受经肝动脉介入化疗栓塞治疗的中晚期原发性肝癌患者,可减轻肝功能损害,降低不良反应程度,提高患者舒适感。

关键词: 原发性肝癌, 经肝动脉栓塞化疗, 还原型谷胱甘肽, 不良反应

Abstract: Objectiv To investigate the protective effect of reduced glutathione （GSH） on liver function in patients with advanced primary liver cancer （PLC） underwent transarterial chemoembolization （TACE）. Methods 138 patients with PLC were recruited in our hospital between February 2010 and July 2014,and were randomly divided into the observation group （n=71） and the control group （n=67）. All patients with PLC received TACE, and those in the observation were treated intravenously with GSH for seven days after TACE. Results At the end of three months,the CT scan showed that the partial response （PR） and stable disease （SD） in the observation group were 23.9% and 60.6%,without significant differences as compared to 20.9% and 58.2%,respectively in the control （P>0.05）;at the end of 10 days,serum ALT and AST levels in the observation were （75.4±18.9）U/L and （101.6±18.4） U/L,significantly lower than 【（98.6±20.4） U/L and （121.2±30.4） U/L,respectively,P<0.05】 in the control;at the end of 2 weeks,the incidences of gastrointestinal reactions,leukopenia,decreased blood hemoglobin levels,and thrombocytopenia in the observation group were 26.8%,22.5%,19.7% and 2.8% respectively,while they were 32.8% （P<0.05）,28.4%,29.9% （P<0.05） and 6.0% in the control;the six-month survival rate in the observation group was 91.5%（65/71）,without significant difference as compared to 85.1%（57/67,P>0.05） in the control and one-year survival rate in the observation group was 84.5%（60/71）,much higher than （61.2% （41/67,P<0.05） in the control group. Conclusion Application of reduced glutathione after TACE in patients with primary liver cancer might alleviate liver function injuries,and decrease the incidence of side effects in this settings.

Key words: Hepatoma, Transarterial chemoembolization, Reduced glutathione, Side effect

赵晓光, 史玉洁. 应用还原型谷胱甘肽预防处理接受TACE治疗的中晚期原发性肝癌患者对肝功能的影响[J]. 实用肝脏病杂志, 2019, 22(3): 425-428.

Zhao Xiaoguang, Shi Yujie. Protective effect of reduced glutathione on liver function in patients with advanced primary liver cancer underwent transarterial chemoembolization[J]. JOURNAL OF PRACTICAL HEPATOLOGY, 2019, 22(3): 425-428.

参考文献

[1] Torner A,Stokkeland K,Svensson A,et al.The underreporting of hepatocellular carcinoma to the cancer register and a log-linear model to estimate a more correct incidence. Hepatology,2017,65(3):885-892.
[2] 张世同,金建军,白艳丽,等. TACE术后接受恩替卡韦治疗血清HBV DNA阴性的中晚期原发性肝癌患者生存率研究. 实用肝脏病杂志,2018,21(1):100-103.
[3] Subastri A,Suyavaran A,Preedia BE,et al.Troxerutin with copper generates oxidative stress in cancer cells:Its possible chemotherapeutic mechanism against hepatocellular carcinoma. J Cell Physiol,2018,233(3):1775-1790.
[4] Anderton B,Camarda R,Balakrishnan S,et al.MYC-driven inhibition of the glutamate-cysteine ligase promotes glutathione depletion in liver cancer. EMBO Rep,2017,18(4):569-585.
[5] Dos SLM,da STM,Azambuja JH,et al. Methionine and methionine sulfoxide treatment induces M1/classical macrophage polarization and modulates oxidative stress and purinergic signaling parameters. Mol Cell Biochem,2017,424(1-2):69-78.
[6] 中华人民共和国卫生和计划生育委员会医政医管局. 原发性肝癌诊疗规范(2017年版). 中华消化外科杂志,2017,16(7):705-720.
[7] Vrzal R,Illes P,Dvorak Z.Transplant drugs affect the expression of phase II and antioxidant enzymes in human carcinoma cells HepG2 but not in primary cultures of human hepatocytes:In vitro comparative study. Pharmacol Rep,2016,68(5):1008-1014.
[8] Korean Liver Cancer Study Group (KLCSG),National Cancer Center,Korea(NCC). 014 Korean Liver Cancer Study Group-National Cancer Center Korea practice guideline for the management of hepatocellular carcinoma. Korean J Radiol,2015,16(3):465-522.
[9] Li A,Ma S,Pawlik T,et al.Surgical treatment of double primary liver cancer:An observational study for a rare type of tumor. Medicine,2016,95(32):e4412.
[10] Deas E,Cremades N,Angelova PR,et al.Alpha-synuclein oligo-mers interact with metal ions to induce oxidative stress and neuronal death in Parkinson's disease. Antioxid Redox Signal,2016,24(7):376-391.
[11] Wang J,Shen JL.Spectral CT in evaluating the therapeutic effect of transarterial chemoembolization for hepatocellular carcinoma:a retrospective study. Medicine,2017,96(52):e9236.
[12] Xiao Z,Lorent K,Wilkins BJ,et al.Glutathione antioxidant pathway activity and reserve determine toxicity and specificity of the biliary toxin biliatresone in zebrafish. Hepatology,2016,64(3):894-907.
[13] Amirtharaj GJ,Natarajan SK,Pulimood A,et al.Role of oxygen free radicals,nitric oxide and mitochondria in mediating cardiac alterations during liver cirrhosis induced by thioacetamide. Cardiovasc Toxicol,2016,17(2):175-184.
[14] 侯帅,樊琳琳,戴光荣. 非手术治疗原发性肝癌研究进展. 实用肝脏病杂志,2016,19(2):249-252.
[15] JMJ J,van der Waals LM,Trumpi K,et al. Downregulation of DNA repair proteins and increased DNA damage in hypoxic colon cancer cells is a therapeutically exploitable vulnerability. Oncotarget,2017,8(49):86296-86311.
[16] Villablanca JG,Volchenboum SL,Cho H,et al.A phase I new approaches to neuroblastoma therapy study of buthionine sulfoximine and melphalan with autologous stem cells for recurrent/refractory high-risk neuroblastoma. Pediatr Blood Cancer,2016,63(8):1349-1356.
[17] Wang X,Fan Y,Du Z,et al.Knockdown of phospholipase C (PLC) inhibits cell proliferation via phosphatase and tensin homolog deleted on chromosome 10(PTEN)/AKT signaling pathway in human prostate cancer. Med Sci Monit,2018,24(2):254-263.
[18] Stepien M,Fedirko V,Duarte-Salles T,et al.Prospective association of liver function biomarkers with development of hepatobiliary cancers. Cancer Epidemiol,2016,40(Suppl 1):179-187.
[19] Baltruskeviciene E,Kazbariene B,Badaras R,et al.Glutathione and glutathione S-transferase levels in patients with liver metastases of colorectal cancer and other hepatic disorders. Cancer Control,2016,27(4):336-341.
[20] Naeem F,Johal R,Mckenna C,et al.Cognitive behavior therapy for psychosis based guided self-help (CBTp-GSH) delivered by frontline mental health professionals:results of a feasibility study. Schizophr Res,2016,173(1-2):69-74.