中国药物警戒 ›› 2019, Vol. 16 ›› Issue (4): 203-207.

• 基础与临床研究 • 上一篇    下一篇

不同预防性保肝用药方案对急性髓系白血病首次化疗后肝损伤的影响

杨忠毅1, 曹江2,*   

  1. 1常州市金坛区人民医院药剂科,江苏 金坛 213200;
    2徐州医科大学附属医院血液科,江苏 徐州 221002
  • 收稿日期:2019-05-09 修回日期:2019-05-09 出版日期:2019-04-20 发布日期:2019-05-09
  • 通讯作者: 曹江,男,博士,副主任医师,白血病规范化诊疗。E-mail: zimu05067@163.com。
  • 作者简介:杨忠毅,男,专科,主管药师,临床药学。
  • 基金资助:
    江苏省科技厅社会发展面上项目（BE2017639）：全人抗源CD19CAR-T细胞治疗难治/复发急性B淋巴细胞白血病的基础及临川研究

Effects of Different Prophylactic Liver Protection Drug Regimens on Liver Injury after First Chemotherapy in Patients with Acute Myeloid Leukemia

YANG Zhongyi1, CAO Jiang2,*   

  1. 1Department of Pharmacy, People's Hospital of Jintan District of Changzhou City, Jiangsu Jintan 213200, China;
    2Department of Hematology, Affiliated Hospital of Xuzhou Medical University, Jiangsu Xuzhou 221002, China
  • Received:2019-05-09 Revised:2019-05-09 Online:2019-04-20 Published:2019-05-09

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摘要： 目的 考察不同预防性保肝用药方案对急性髓系白血病首次化疗后肝损伤情况的影响。方法 选取2015年1月至2017年12月在我院住院治疗的急性髓系白血病患者160例进行前瞻性研究,分为对照组（40例）、还原性谷胱甘肽组（GSH组,60例）和异甘草酸镁组（ISO组,60例）。对照组患者仅给予化疗药物,GSH组患者给予还原性谷胱甘肽,ISO患者给予异甘草酸镁,分别于化疗前后测定天冬氨酸氨基转移酶（AST）、碱性磷酸酶（ALP）、丙氨酸氨基转移酶（ALT）及总胆红素（TBil）的水平,并采用酶联免疫吸附测定法（ELISA）测定白介素-6（IL-6）和肿瘤坏死因子-α（TNF-α）的水平,同时对化疗效果及各组患者的药物性肝损伤情况进行分析。结果 3组患者的化疗效果,组间比较,差异均无统计学意义（P >0.05）;化疗前,3组患者的AST、ALT、ALP、Tbil、IL-6及TNF的水平相比,差异均无统计学意义（P >0.05）;与对照组和GSH组相比,ISO组患者化疗后血清AST、ALT、ALP及TBil的水平及差值均显著降低,差异具有统计学意义（P <0.05）;与对照组和GSH组相比,ISO组患者化疗后血清IL-6及TNF-α的水平均显著降低,而差值显著增加,差异具有统计学意义（P <0.05）。对照组患者药物性肝损伤13例（32.50%）,GSH组15例（25.00%）;ISO组患者肝损伤7例（11.67%）,显著低于对照组和GSH组（P <0.05）;而对照组和GSH组药物性肝损伤发生率相比,差异无统计学意义（P >0.05）。结论 异甘草酸镁能够改善急性髓系白血病首次化疗后的肝脏损伤情况,降低血清炎症因子,发挥保护肝脏的作用。

关键词: 急性髓系白血病, 药物性肝损伤, 化疗, 异甘草酸镁, 还原性谷胱甘肽

Abstract: Objective To investigate the effect of different prophylactic liver protection drug regimens on liver injury after first chemotherapy in patients with acute myeloid leukemia. Methods 160 cases of patients with acute myeloid leukemia admitted between January 2015 and December 2017 were collected in our hospital for this prospective study. The patients were divided into control group (40 cases), glutathione (GSH) group (60 cases) and isoglycyrrhizinatel (ISO) group (60 cases). The control group was given chemotherapy only, the GSH group and the ISO group were additionally given GSH and ISO, respectively. The serum levels of aspartate aminotransferase (AST), alkaline phosphatase (ALP), alanine aminotransferase (ALT) and total bilirubin (TBil) pre- and post- chemotherapy were tested. The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) were measured by enzyme linked immunosorbent assay (ELISA). Meanwhile, the chemotherapy and the drug-induced liver injury of the three groups were analyzed. Results There was no significant difference in the efficacy of chemotherapy among the three groups (P>0.05). The pre-chemotherapy serum levels of AST, ALT, ALP, TBil, IL-6 and TNF-α were comparable (P>0.05) among the three groups. The post-chemotherapy serum level of AST, ALT, ALP and TBil and their changes from baseline of the ISO group were lower than control group and GSH group statistically (P <0.05). The post-chemotherapy serum level of IL-6 and TNF-α of the ISO group were lower than the control group and GSH group significantly (P <0.05); and their changes from baseline were higher than the latter two groups significantly (P<0.05). There were 13 cases (32.50%) and 15 cases (25.00%) of drug-induced liver injury in the control group and GSH group, respectively, without significant (P >0.05) difference between the two groups; while there were 7 cases (11.67%) in the ISO group, which was significantly (P <0.05) lower than the control group and GSH group. Conclusion ISO can improve the liver injury after first chemotherapy in patients with the acute myeloid leukemia, decrease the serum inflammatory factors, so it can play a role in protecting the liver.

Key words: acute myeloid leukemia, drug-induced liver injury, chemotherapy, isoglycyrrhizinatel, glutathione

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