低剂量化疗药的TACE术对原发性肝癌患者肝纤维化的影响

目的探讨低剂量与常规剂量化疗药物经动脉导管灌注化疗栓塞术（transcather arterial chemoembolization,TACE）对原发性肝癌患者血清肝纤维化指标的影响。方法 38例原发性肝癌患者按随机数字表法分为A组（18例）、B组（20例）。A组应用低剂量化疗药物,B组应用常规剂量化疗药物。均行TACE术,TACE术≥2次,手术间隔4周以上,分别检测第1次术前、术后7 d,第2次术后1个月患者血清中纤维化指标,包括透明质酸（HA）、层粘连蛋白（LN）、人Ⅲ型前胶原（hPC-Ⅲ）、Ⅳ型前胶原（Ⅳ-C）,共3次。同时观察近期远期疗效。结果 TACE术前血清肝纤维化指标2组间差异无统计学意义（P〉0.05）,低剂量组术后肝纤维化指标低于常规组（P〈0.05）,低剂量组术后肝纤维化指标与术前比较差异无统计学意义（P〉0.05）。低剂量组与常规剂量组中位生存期分别为12.2、11.8个月;6个月,1、2年生存率分别为83.3%、70.0%,61.1%、50.0%,33.3%、25.0%,差异无统计学意义（P〉0.05）。结论原发性肝癌患者采用低剂量化疗药物TACE术可取得与常规剂量化疗药物一样的疗效,减轻肝纤维化的发生。

Effect of Transcatheter Arterial Chemoembolization with Low-Dose Chemotherapy Drug on Fibrosis in Patients with Hepatocellular Cancinoma

Objective To explore the effects of transcatheter arterial chemoembolization（TACE） with low-dose and conventional-dose chemotherapy drugs on serum markers of liver fibrosis in patients with hepatocellular cancinoma（HCC）.Methods Thirty-eight patients with primary HCC were randomly assigned to receive either low-dose chemotherapy drug（18 patients,group A） or conventional-dose chemotherapy drug（20 patients,group B）.All patients underwent more than 1 TACE with more than 4 weeks of interval.The serum markers of liver fibrosis,including hyaluronic acid（HA）,laminin（LN）,human procollagen type Ⅲ（hPC-Ⅲ） and collagen type-IV（IV-C）,were detected before TACE and 7 days after the first TACE and 1 month after the second TACE.The short-term and long-term effects were observed.Results There were no significant differences in serum markers between gourp A and group B before TACE（P0.05）.After TACE,serum markers in group A were significantly lower than those in group B（P0.05）,but were not different from preoperative levels（P0.05）.Median survival time was 12.2 months and 11.8 months in group A and group B,respectively.Sixmonth,1-year and 2-year survival rates were 83.3%,61.1% and 33.3% in group A,respectively,and 70.0%,50.0% and 25.0% in group B,respectively.No significant differences in median survival time and survival rates were observed between the two groups（P0.05）.Conclusion Low-dose of chemotherapy drug can achieve consistent effect with conventional-dose chemotherapy drug in TACE,and may reduce liver fibrosis in patients with HCC.