TACE 治疗原发性肝癌对肝功能的影响及相关因素的研究

摘要

目的：探讨TACE治疗原发性肝癌患者对肝功能的影响及相关因素。方法收集120例原发性肝癌患者，观察TACE治疗前后对肝功能的影响，同时观察影响肝功能的相关因素。结果（1） TACE治疗后3 d、1周复查肝功能ALT、AST、TBIL、DBIL较术前升高，差异均有统计学意义（ P＜0．05）。术后3 d肝功能与术后1周比较，ALT、AST下降、ALB上升、PT时间缩短，差异有统计学意义（P＜0．05）；1个月后复查肝功能，与治疗前相比，差异无统计学意义（P＞0．05）；（2）TACE治疗次数对肝功能的影响：TACE 1次48例，TACE 2次45例，TACE≥3次27例，三组比较差异有统计学意义（ P＜0．05）。（3）合并门脉癌栓患者，TACE治疗后肝功能损伤发生率影响：有门脉癌栓31例，无门脉癌栓89例，两组比较差异有统计学意义（P＜0．05）。（4）TACE治疗患者中HBeAg阳性36例；HBeAg阴性59例，HBeAg阳性者肝功能损伤发生率增高，两组比较差异有统计学意义（P＜0．05）。（5）TACE治疗患者中，HBV DNA低滴度58例、中高滴度38例，两组肝功能损伤发生率比较差异有统计学意义（P＜0．05）。（6）Child-Pugh B级患者， HBV DNA低滴度与中高滴度肝功能损害发生率比较，差异有统计学意义（ P＜0．05）。结论原发性肝癌TACE治疗后3～7 d，肝功能损伤较重，随着时间的延长，肝功能逐渐好转。 TACE次数、门脉癌栓、Child-Pugh分级、HBV感染是TACE治疗原发性肝癌肝功能损伤相关因素。%Objective To study the effect of TACE for liver function in hepatocellular carcinoma and related factors. Methods One hundred and twenty hepatocellular carcinoma patients who received TACE treatment were collected.The effect of TACE for liver function was observed before and after treatment, and the related factors were analyzed.Results (1) ALT, AST, TBIL, DBIL after 3 days and one week TACE treatment were higher than the pre-operation ( P<0.05).Compared with one week TACE treatment, ALT, AST were decreased, ALB was increased, PT was shorted af-ter 3 days TACE treatment ( P<0.05) .There was no difference in the liver function indexes between pre-operation and after one month (P>0.05);(2) TACE 1 time accounted for 40%(48 cases), TACE 2 times accounted for 37.5%(45 cases), TACE≥3 times accounted for 22.5% (27 cases), there was significant difference among three groups (P<0.05).(3) Patients with portal vein tumor thrombus accounted for 51.67%(31 cases), patients without portal cancerous thrombus accounted for 48.33%(89 cases) , there was significant difference in the liver function indexes be-tween two groups (P<0.05).(4) The positive rate of HBeAg was 37.89% (36 cases), HBeAg negative rate was 62.11%(59 cases), there was significant difference in liver injury rate between two groups (P<0.05).(5) Low titer of HBV DNA was 58 cases, middle and high titer of HBV DNA was 38 cases, there was significant difference in liver in-jury rate between two groups (P<0.05).(6) In 34 cases of Child-Pugh B level patients, low titer of HBV DNA was 15 cases, middle and high titer of HBV DNA was 18 cases, there was significant difference in liver injury rate between two groups (P<0.05).Conclusion TACE can cause liver function injury, within three to seven days after TACE, but with the extension of time, the liver function is gradually improving. Times of TACE, portal vein tumor thrombus, Child-Pugh classification and HBV infection are related factors of liver function injury after TACE.