Abstract:

Objective　To observe the effect of low-dose dexamethasone as an adjunct to transcatheter arterial chemoembolization (TACE) in the treatment of patients with hepatic cell carcinoma (HCC). Methods　One hundred and sixteen patients with HCC admitted to First Hospital, Nanyang Medical College from January 2021 to March 2023 were selected for the randomized controlled trial. The enrolled patients were divided into a conventional group and a combined group by the random number table method, with 58 cases in each group. There were 30 males and 28 females in the conventional group; they were (65.33±5.27) years old. There were 33 males and 25 females in the combined group; they were (65.25±5.33) years old. The conventional group took routine liver protection therapy and TACE, while the combined group low-dose dexamethasone and TACE. The levels of inflammatory factors, endothelial cell function indicators, and liver cell function indicators, incidences of postoperative complications, and medication safety were compared between the two groups. χ² and t tests were applied. Results　Before the treatment, there were no statistical differences in the inflammatory factors, endothelial cell function, and liver function between the two groups (all P>0.05). After the treatment, the levels of interleukin-1 (IL-1), IL-6, and tumor necrosis factor-α (TNF-α) in the combined group were lower than those in the conventional group [(80.35±10.24) ng/L vs. (87.22±10.37) ng/L, (6.25±2.14) ng/L vs. (7.69±2.05) ng/L, and (4.25±1.47) μg/L vs. (5.33±2.06) μg/L], with statistical differences (t=3.590, 3.701, and 3.250; all P<0.05). After the treatment, the levels of 6-kelo-prototype graphic framework1α (6-kelo-PGF1α), endothelin-1 (ET-1), and nitric oxide (NO) in the combined group were (175.25±20.61) ng/L, (62.11±10.47) ng/L, and (55.19±10.25) ppb, and those in the conventional group were (158.74±20.33) ng/L, (70.25±10.33) ng/L, and (61.36±10.33) ppb, with statistical differences (t=4.343, 4.215, and 3.229; all P<0.05). The levels of alanine transaminase (ALT) and glutamic-oxaloacetic transaminase (AST) 3 and 5 d after the treatment in the combined group were lower than those in the conventional group [(48.44±5.21) U/L vs. (51.28±5.44) U/L, (47.25±5.38) U/L vs. (50.66±5.28) U/L, (36.77±5.61) U/L vs. (39.19±5.28) U/L, and (37.25±5.35) U/L vs. (40.61±5.23) U/L], with statistical differences (t=2.871, 3.445, 2.392, and 3.420; all P<0.05). The incidences of TACE related complications and drug adverse reactions in the combined group were lower than those in the conventional group [6.90% (4/58) vs. 18.97% (11/58) and 8.62% (5/58) vs. 22.41% (13/58)], with statistical differences (χ²=6.468 and 7.254; both P<0.05). Conclusions　Low-dose dexamethasone assisted TACE for patients with HCC can effectively inhibit the release of inflammatory factors and reduce vascular endothelial damage, and has a positive effect on alleviating their liver function and reducing the risk of postoperative complications. Compared with conventional liver protection drugs, low-dose dexamethasone is safer.

Key words:

Hepatic cell carcinoma, Transcatheter arterial chemoembolization, Dexamethasone, Liver function, Drug safety

摘要：

目的　观察小剂量地塞米松辅助肝动脉化疗栓塞术（transcatheter arterial chemoembolization，TACE）治疗原发性肝癌（hepatic cell carcinoma，HCC）患者的临床效果。方法　选取南阳医学高等专科学校第一附属医院2021年1月至2023年3月收治的116例HCC患者进行随机对照试验，采用随机数字表法将入组患者分为常规组和联合组，各58例。常规组男30例，女28例，年龄（65.33±5.27）岁。联合组男33例，女25例，年龄（65.25±5.33）岁。常规组采用常规护肝治疗配合TACE，联合组采用小剂量地塞米松配合TACE。比较两组炎症因子、血管内皮细胞功能指标、肝细胞功能指标水平和术后并发症发生情况及用药安全性。采用χ²检验和t检验。结果　治疗前，两组炎症因子、血管内皮细胞功能、肝功能差异均无统计学意义（均P>0.05）；治疗后，联合组白细胞介素-1（interleukin-1，IL-1）、白细胞介素-6（IL-6）、肿瘤坏死因子-α（tumor necrosis factor-α，TNF-α）水平均低于常规组［（80.35±10.24）ng/L比（87.22±10.37）ng/L、（6.25±2.14）ng/L比（7.69±2.05）ng/L、（4.25±1.47）μg/L比（5.33±2.06）μg/L］，差异均有统计学意义（t=3.590、3.701、3.250，均P<0.05）。治疗后，联合组6-酮-前列腺素1α（6-kelo-prototype graphic framework1α，6-kelo-PGF1α）、内皮素-1（endothelin-1，ET-1）、一氧化氮（nitric oxide，NO）水平分别为（175.25±20.61）ng/L、（62.11±10.47）ng/L、（55.19±10.25）ppb，常规组分别为（158.74±20.33）ng/L、（70.25±10.33）ng/L、（61.36±10.33）ppb，差异均有统计学意义（t=4.343、4.215、3.229，均P<0.05）。联合组治疗3 d后丙氨酸氨基转移酶（alanine transaminase，ALT）、天冬氨酸氨基转移酶（glutamic-oxaloacetic transaminase，AST）水平分别为（48.44±5.21）U/L、（47.25±5.38）U/L，均低于常规组［（51.28±5.44）U/L、（50.66±5.28）U/L］（t=2.871、3.445，均P<0.05）；治疗5 d后，联合组ALT、AST水平分别为（36.77±5.61）U/L、（37.25±5.35）U/L，均低于常规组［（39.19±5.28）U/L、（40.61±5.23）U/L］，差异均有统计学意义（t=2.392、3.420，均P<0.05）。治疗后，联合组TACE相关并发症发生率、药物不良反应发生率均低于常规组［6.90%（4/58）比18.97%（11/58）、8.62%（5/58）比22.41%（13/58）］，差异均有统计学意义（χ²=6.468、7.254，均P<0.05）。结论　小剂量地塞米松辅助TACE能有效抑制HCC患者炎症因子释放并减轻血管内皮损伤，对改善肝功能、降低术后并发症发生风险有积极作用，且与常规护肝药物相比，小剂量地塞米松安全性更高。

关键词:

原发性肝癌, 肝动脉化疗栓塞术, 地塞米松, 肝功能, 用药安全性