Clinical Observation Of Magnesium Isoglycyrrhizinate Prevention Of Chemotherapy-induced Liver Injury On Malignant Tumor

Background and objective: Drug-induced liver injury (DILI) is an importantconditioned factor in chemotherapy. How to reduce liver injury has important clinicalimplications for postoperative cancer patients with multiple cycles of chemotherap.Through retrospective analysis of103postoperative cancer cases, which receive MgIGwhile chemotherapy and who did not,analysis their biochemical indicators of liverfunction. Project is designed to provide the basis for clinical prevention and treatment ofchemotherapy-induced liver dysfunction.Method: A total of103patients with malignant tumor hospitalized in OncologyDepartment of the First Affiliated Hospital of Dalian Medical University during January1st2013to December31st2013were collected. including breast cancer, non-small celllung cancer and gastrointestinal tumors. Adjuvant chemotherapy protocols wereepirubicin and cyclophosphamide/epirubicin and cyclophosphamide sequentialdocetaxel/docetaxel in combination with cyclophosphamide (EC/EC-T/TC),docetaxel plus cisplatin (DC) and oxaliplatin (L-OHP) were combined with fluorouracilclass. Before chemotherapy, there were no liver, renal function and electrolyteabnormalities, drug history leading to liver damage, and combined liver-based diseases(such as viral hepatitis, cirrhosis, severe fatty liver, etc.). The prevention group51cases(19males,32females, aged58.27±9.01years old), the first day of periodicchemotherapy, MgIG Injection100mg or150mg were used, intravenous infusion,1 times/d, until the end of chemotherapy. The control group52cases (31males and21females, aged57.04±9.46years), chemotherapy was used without liver protectant.Analyse changes of two groups’ liver functional biochemical indicators, andchemotherapy-induced liver injury on chemotherapy.Results:1.Clinical features:Prevention and control groups of patients are different (p except sex <0.05), therest including age, tumor type, chemotherapy programs have better balance (p>0.05).Liver function indexes of two groups at baseline period have no significant difference(p>0.05), including serum aspartate aminotransferase (AST), alanine aminotransferase(ALT), serum albumin (ALB), serum alkaline phosphatase (ALP), serum glutamylendopeptidase (γ-GT), serum total bilirubin (TBIL).2.Comparison of two groups’s liver function indexes after the first chemotherapyAfter the first cycle of chemotherapy, liver function indexes and each indexcorresponding to the difference between the baseline period, ALB and TBIL differencewas no significant (P>0.05), while AST, ALT, ALP and γ-GT of prevention groupwere significantly lower than the control group, the difference was statisticallysignificant (P <0.05).3. Comparison of abnormal liver function in different levelsDuring chemotherapy, the incidence of liver function abnormalities of thelow-grade in prevention group (grade I) was29.41%(15/51), lower than the incidencein control group44.23%(23/52), but the difference was not statistically significant (χ2=2.429, P=0.119>0.05). he incidence of liver function abnormalities of the high-grade in prevention group (grade Ⅱ~Ⅳ) was9.80%(5/51), lower than the incidencein control group26.92%(14/52), the difference was statistically significant (χ2=5.016,P=0.025<0.05)4. Comparison of the incidence of liver damage during chemotherapyDuring chemotherapy, the incidence of liver damage in prevention group9.80%(5/51), lower than the control group25.00%(13/52), the two sets of data were compared by χ2test: χ2=4.123, P <0.05, the difference was statistically significant.5.chemotherapy postponed and chemotherapy dose reduction5.1Chemotherapy postponed:51patients of prevention group received a total of292cycles of chemotherapy. Chemotherapy-induced liver injury resulted inchemotherapy delayed for three cycles of chemotherapy, nearly1.03%of the wholechemotherapy cycle(3/292).52patients of control group received a total of295cyclesof chemotherapy, Chemotherapy-induced liver injury resulted in chemotherapy delayedfor11cycles of chemotherapy, nearly3.73%of the whole chemotherapycycle(11/295). Tested by χ2test,χ2=4.572, P <0.05, the difference was statisticallysignificant.5.2Chemotherapy drugs reductions: In prevention group, chemotherapydrug-induced liver injury resulted in reductions of4cycles of chemotherapy,1.37%ofthe whole chemotherapy cycles (4/292). In control group, chemotherapy drug-inducedliver injury resulted in reductions of11chemotherapy cycles of chemotherapy,4.41%of the whole chemotherapy cycles (13/295), Tested by χ2test, χ2=4.813, P <0.05, thedifference was statistically significant.6. Types of liver injury, the relationship between liver injury and chemotherapycycle6.1Types of liver injury: after chemotherapy, there are18cases of drug-inducedliver injury in103patients, including hepatocellular liver injury accounted for66.67%(12/18), cholestasis type accounted for22.22%(4/18), the mixed type accountedfor11.11%(2/18).6.2The relationship between liver injury and chemotherapy cycle:18cases ofdrug-induced liver injury occurred in the first2-4cycles of chemotherapy(14/18,77.78%).Conclusion:1. Preventive application of MgIG in chemotherapy can effectively reduce elevatedaminotransferases, it can make the degree of abnormal liver function significantlyrelieve, the incidence of chemotherapy-induced liver injury reduces. 2. Preventive application of MgIG in chemotherapy can effectively reduce delaysand dose reduction caused by liver damage during chemotherapy.3. Most common type of chemotherapy-induced liver dysfunction is hepatocellularnecrosis, liver injury occurred mainly in the first2-4cycles of chemotherapy,chemotherapy-induced liver dysfunction in Ⅰ degree.