Nomura H, Miyake K, Hirakata R, Migita S, Okamoto O, Shiraishi G
Department of Internal Medicine, Shin-Kokura Hospital, Kanada, Kitakyushu, Japan.
J Gastroenterol Hepatol. 1999 May;14(5):495-9. doi: 10.1046/j.1440-1746.1999.01889.x.
Transcatheter arterial embolization (TAE) of the hepatic artery is a common treatment method for hepatocellular carcinoma (HCC), but it often induces gastric mucosal injury. We examined whether or not rebamipide administration, beginning 1 week before and ending 2 weeks afterTAE, can prevent worsening of gastric mucosal disorders.
The subjects were 73 chronic hepatitis C or type C liver cirrhosis patients who concomitantly had HCC and received TAE in our hospital. The patients were randomly allocated to the rebamipide group (oral, 300 mg/day for 3 weeks starting 1 week before TAE) or the non-rebamipide group. Gastric endoscopy was performed 1 week before and 2 weeks afterTAE and the presence of erythema, erosion and/or submucosal haemorrhagic spots was monitored. Based on the findings, gastric mucosal disorder before and after TAE was quantitatively evaluated using the modified Lanza score (MLS).
Overall, MLS after TAE increased significantly (P< 0.05). However, in the rebamipide group, MLS did not change. The MLS after TAE increased significantly in patients who had either liver cirrhosis, oesophageal varices or gastropathy (P< 0.01 or < 0.05). In the non-rebamipide group, a significant increase in MLS after TAE was observed in patients who had one of the above-mentioned three diseases (P< 0.01 or < 0.05).
Gastric lesions which were present before TAE were significantly worsened after TAE. Rebamipide administration prevents TAE-induced aggravation of gastric lesions.
经导管肝动脉栓塞术(TAE)是肝细胞癌(HCC)的一种常见治疗方法,但它常引发胃黏膜损伤。我们研究了在TAE前1周开始并在TAE后2周结束给予瑞巴派特,是否能预防胃黏膜病变的恶化。
研究对象为73例合并HCC并在我院接受TAE的慢性丙型肝炎或丙型肝硬化患者。患者被随机分为瑞巴派特组(口服,从TAE前1周开始,300mg/天,共3周)或非瑞巴派特组。在TAE前1周和TAE后2周进行胃镜检查,监测红斑、糜烂和/或黏膜下出血点的存在情况。根据检查结果,使用改良兰扎评分(MLS)对TAE前后的胃黏膜病变进行定量评估。
总体而言,TAE后MLS显著升高(P<0.05)。然而,在瑞巴派特组中,MLS没有变化。在患有肝硬化、食管静脉曲张或胃病的患者中,TAE后的MLS显著升高(P<0.01或<0.05)。在非瑞巴派特组中,患有上述三种疾病之一的患者TAE后MLS显著升高(P<0.01或<0.05)。
TAE前存在的胃部病变在TAE后显著恶化。给予瑞巴派特可预防TAE引起的胃部病变加重。