奥沙利铂致肝窦阻塞综合征患者脾脏体积和肝纤维化指数变化分析

肝脏 ›› 2021, Vol. 26 ›› Issue (5): 550-553.

奥沙利铂致肝窦阻塞综合征患者脾脏体积和肝纤维化指数变化分析

付雪林, 邓军, 黄小宁, 李五根, 彭碧波, 李春来, 龚良庚

330006 江西南昌大学第二附属医院医学影像中心(付雪林, 邓军, 黄小宁, 李五根, 彭碧波, 龚良庚),肿瘤科(李春来)

收稿日期:2020-07-30 出版日期:2021-05-31 发布日期:2021-06-17
通讯作者: 邓军,Email:doctordengjun@163.com
基金资助:
江西省教育厅科学技术研究项目(14069),江西省卫生健康委科技计划项目(202130388)

Analysis of the changes of spleen volume and liver fibrosis index in patients with oxaliplatin-induced sinusoidal injury

FU Xue-lin¹, DENG Jun¹, HUANG Xiao-ning¹, LI Wu-gen¹, PENG Bi-bo¹, LI Chun-lai², GONG Liang-geng¹

1. Department of Radiology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China;
2. Department of Oncology, the Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi 330006, China

Received:2020-07-30 Online:2021-05-31 Published:2021-06-17
Contact: DENG Jun,Email:doctordengjun@163.com

摘要/Abstract

摘要： 目的分析肿瘤患者化学治疗前后脾脏体积及肝纤维化指数APRI、FIB-4的变化特征。方法选取南昌大学第二附属医院2017年7月至2019年6月接受以奥沙利铂为基础化疗方案的胃癌、结直肠癌患者共63例。收集患者化疗前及化疗期间的上腹部CT图像、血小板计数、AST和ALT等数据,应用后处理软件测量患者的脾脏体积,根据公式计算出APRI和FIB-4值,对这些数值进行统计学分析。结果奥沙利铂化疗前患者脾脏体积为(196.91±90.63)cm³,化疗结束时为(276.27±135.05)cm³,其中32(50.8%)例患者脾脏体积增大超过30%。化疗前患者APRI、FIB-4值分别为(0.28±0.15)、(1.28±0.60),第7个化疗周期末分别为(1.11±0.99)、(3.53±2.15)。APRI、FIB-4值在前3个化疗周期内迅速增长,随后增长缓慢;在各化疗周期,APRI与FIB-4间增长幅度均具有良好的相关性(P<0.05)。化疗期间末次CT脾脏体积较化疗前增大百分比与同一时间APRI、FIB-4增大百分比之间呈正相关(P<0.01),相关系数分别为0.362、0.582。结论脾脏体积及肝纤维化指数APRI、FIB-4值,随着奥沙利铂化疗周期的增加而逐渐增大,可作为监测奥沙利铂致肝窦阻塞综合征的无创性生物学指标。

关键词: 奥沙利铂, 肝窦阻塞综合征, 脾脏体积, APRI, FIB-4

Abstract: Objective To analyze the characteristic changes of spleen volume and liver fibrosis indexes (APRI, FIB-4) in patients with cancer treated with oxaliplatin as basic chemotherapy regimen during the administration period.Methods A total of 63 patients with gastric cancer and colorectal cancer who received oxaliplatin-based chemotherapy from July 2017 to June 2019 were selected. The data of CT image of upper abdomen, platelet count, AST and ALT in patients before and during chemotherapy were collected. The spleen volume of the patients was measured by post-processing software, and the APRI and FIB-4 values were calculated according to the formulas. Results The spleen volume and liver fibrosis indexes of tumor patients showed a trend of gradual increase during oxaliplatin chemotherapy. The volume of spleen was (196.91±90.63)cm³ before oxaliplatin chemotherapy, and increased to (276.27±135.05)cm³ by the last CT examination during chemotherapy. The speen wolume of 32 (50.8%) patients increased by more than 30%. The APRI and FIB-4 of patients were (0.28±0.15) and (1.28±0.60) before oxaliplatin chemotherapy respectively, which increased to (1.11±0.99) and (3.53±2.15) by the end of the seventh chemotherapy cycle. The values of APRI and FIB-4 increased rapidly during the first three chemotherapy cycles of patients, and then increased slowly; in each chemotherapy cycle, the growth rates of APRI and FIB-4 had a good correlation (P<0.05). There also was a positive correlation between the increased percentage in spleen volume measured at the last CT examination during chemotherapy and the increased percentage in APRI and FIB-4 obtained at the same time (P<0.01), with correlation coefficients of 0.362 and 0.582, respectively.Conclusion Along with the increase of oxaliplatin-based chemotherapy cycle, spleen volume and liver fibrosis indexes (APRI, FIB-4) increased gradually, and could be used as noninvasive biological indexes to monitor the oxaliplatin-induced sinusoidal injury.

Key words: Oxaliplatin, Hepatic sinusoidal obstruction syndrome, Spleen volume, APRI, FIB-4

付雪林, 邓军, 黄小宁, 李五根, 彭碧波, 李春来, 龚良庚. 奥沙利铂致肝窦阻塞综合征患者脾脏体积和肝纤维化指数变化分析[J]. 肝脏, 2021, 26(5): 550-553.

FU Xue-lin, DENG Jun, HUANG Xiao-ning, LI Wu-gen, PENG Bi-bo, LI Chun-lai, GONG Liang-geng. Analysis of the changes of spleen volume and liver fibrosis index in patients with oxaliplatin-induced sinusoidal injury[J]. Chinese Hepatolgy, 2021, 26(5): 550-553.

参考文献

[1] Iwai T, Yamada T, Koizumi M, et al. Oxaliplatin-induced increase in splenic volume; irreversible change after adjuvant FOLFOX. J Surg Oncol, 2017, 116:947-953.
[2] Stevenson HL, Prats MM, Sasatomi E. Chemotherapy-induced Sinusoidal Injury (CSI) score: a novel histologic assessment of chemotherapy-related hepatic sinusoidal injury in patients with colorectal liver metastasis. BMC Cancer, 2017, 17:35.
[3] Puente A, Fortea JI, Del Pozo C, et al. Porto-Sinusoidal Vascular Disease Associated to Oxaliplatin: An Entity to Think about It. Cells, 2019, 8:1506.
[4] Volin L, Niittyvuopio R, Heiskanen J, et al. Diagnosis of veno-occlusive disease/sinusoidal obstruction syndrome of the liver: problems of interpretation. Bone Marrow Transplant, 2016, 51:1633-1635.
[5] Wai CT, Greenson JK, Fontana RJ, et al. A simple noninvasive index can predict both significant fibrosis and cirrhosis in patients with chronic hepatitis C. Hepatology, 2003, 38:518-526.
[6] Sterling RK, Lissen E, Clumeck N, et al. Development of a simple noninvasive index to predict significant fibrosis in patients with HIV/HCV coinfection. Hepatology, 2006, 43:1317-1325.
[7] 朱成凯, 张峰, 诸葛宇征, 等. 菊三七相关肝窦阻塞综合征115例的临床特征分析. 中华消化杂志, 2017, 37:448-452.
[8] 刘丽艳, 唐晓雯, 胡丽, 等. 113例药物性肝损伤的回顾性分析. 肝脏, 2020, 25:387-389.
[9] 王湘, 赵林. 结直肠癌辅助化疗回顾与进展. 实用肿瘤杂志, 2019, 34:479-485.
[10] Lee JH. Biomarkers for hepatic sinusoidal obstruction syndrome after hematopoietic cell transplantation. Blood Res, 2015, 50:123-125.
[11] 张晨曦, 卞勉励, 陈星燃, 等. 肝窦内皮细胞在肝脏疾病中的作用. 中国药理学通报, 2017, 33:149-153.
[12] 李胤蒴, 保洁, 徐芸, 等. 16例吡咯烷生物碱相关肝窦阻塞综合征的临床病理分析. 中华肝脏病杂志, 2020, 28: 332-337.
[13] Cayet S, Pasco J, Dujardin F, et al. Diagnostic performance of contrast-enhanced CT-scan in sinusoidal obstruction syndrome induced by chemotherapy of colorectal liver metastases: Radio-pathological correlation. Eur J Radiol, 2017, 94:180-190.
[14] Imai K, Emi Y, Iyama KI, et al. Splenic volume may be a useful indicator of the protective effect of bevacizumab against oxaliplatin-induced hepatic sinusoidal obstruction syndrome. Eur J Surg Oncol, 2014, 40:559-566.
[15] Pereyra D, Rumpf B, Ammann M, et al. The Combination of APRI and ALBI Facilitates Preoperative Risk Stratification for Patients Undergoing Liver Surgery After Neoadjuvant Chemotherapy. Ann Surg Oncol, 2019, 26:791-799.