天晴甘平对恶性淋巴瘤综合化疗后肝功能保护的临床研究

摘要

目的：探讨天晴甘平(甘草酸二铵肠溶胶囊)对恶性淋巴瘤综合化疗后肝功能的保护与治疗作用。方法选择2013年1月至2014年12月期间我院血液科收治的恶性淋巴瘤住院化疗患者75例，将其按照化疗前后的肝功能情况分为三组：观察组16例，为化疗前伴有肝功能损伤或肝脏疾病史者；余59例患者为化疗前未出现肝功能异常或无肝脏疾病史者，根据对等原则分为天晴甘平预防组29例和对照组30例。观察组与预防组化疗前采取天晴甘平进行治疗或预防，对照组在化疗过程中采用葡萄糖胰岛素氯化钾注射液以及服用益肝灵片进行肝脏保护。观察并比较三组患者化疗后药物性肝功能损害的发生率以及化疗前后的肝功能各功指标变化情况。结果预防组和观察组化疗后药物性肝损发生率分别为6.90%和32.25%，而对照组的药物性肝损发生率高达60.00%，预防组、观察组化疗后药物性肝损发生率显著低于对照组，差异均有统计学意义(P<0.01或0.05)；在化疗时间≥20 d患者中，预防组、观察组药物性肝损发生率也明显低于对照组，差异均有统计学意义(P<0.01或0.05)；观察组患者化疗后谷丙转氨酶(ALT)、门冬氨酸氨基转移酶(AST)、碱性磷酸酶(ALP)以及β谷胺酰转肽酶(GGT)水平比化疗前均明显降低，差异均有统计学意义(P<0.05或0.01)，而血清总胆红素(TB)、白蛋白(ALB)水平化疗前后比较差异均无统计学意义(P>0.05)；预防组化疗前后各项肝功能指标值比较差异均无统计学意义(P>0.05)；对照组化疗后的ALT与GGT水平比治疗前均明显上升(P<0.05)，而化疗前后患者的AST、ALB、ALP以及TB水平则均无明显变化，差异均无统计学意义(P>0.05)。结论天晴甘平对恶性淋巴瘤患者化疗后肝功能具有非常好的保护性，能有效预防或者降低化疗后的肝功能损害，并能快速、有效地将损伤的肝脏功能恢复正常。%Objective To explore the protective and therapeutical role of TianQingGanPing (Glycyrrhizic ac-id diamine enteric capsules) on liver function after comprehensive chemotherapy in patients with malignant lympho-ma. Methods A total of 75 patients with malignant lymphoma undergoing chemotherapy in Department of Hematol-ogy in our hospital from Jan. 2013 to Dec. 2014 were enrolled in the study, which were divided into three groups ac-cording to the liver function before and after chemotherapy:observation group (16 patients with liver function injury or history of liver disease before chemotherapy), prevention group (29 of the 59 patients without liver function injury or history of liver disease before chemotherapy), control group (30 of the 59 patients without liver function injury or history of liver disease before chemotherapy). The observation group and prevention group applied TianQingGanPing for prevention and treatment before chemotherapy, while the control group used glucose-insulin and potassium chlo-ride injection and Yi Ganling Tablet for liver protection in the process of chemotherapy. The incidence of drug-induced liver function injury after chemotherapy and changes of liver function indexes before and after chemotherapy were compared between the three groups. Results The incidence of drug-induced liver function injury after chemotherapy were 6.90%in the prevention group and 32.25%in the observation group, significantly lower than 60.00%in the con-trol group (P<0.01 or P<0.05). For patients undergoing chemotherapy for more than 20 d, the incidence of drug-in-duced liver function injury in the prevention group and the observation group was significantly lower than that in the control group (P<0.01 or P<0.05). In the observation group, the alanine aminotransferase (ALT), aspartate ami-no-transferase (AST), alkaline phosphatase (ALP) andγ-glutamyltranspetidase (GGT) level after chemotherapy were significantly lower than those before chemotherapy (P<0.01 or P<0.05), while serum total bilirubin (TB), and albumin (ALB) showed no statistically significant difference before and after chemotherapy (P>0.05). In the prevention group,the liver function indexes all showed no statistically significant difference before and after chemotherapy (P>0.05). In the control group, ALT and GGT levels after chemotherapy were significantly increased compared with those before treatment (P<0.05), while AST, ALB, ALP and TB levels had no significant changes before and after chemo-therapy (P>0.05). Conclusion TianQingGanPing has significant protective effect on the liver function after chemo-therapy in patients with malignant lymphoma, which can effectively prevent or reduce the liver function injury after chemotherapy, and help quickly and efficiently return the liver function injury to normal.