Ballauff A, Krähe J, Jansen B, Ross R S, Roggendorf H, Havers W
Kinderklinik, Gesamthochschule Essen.
Klin Padiatr. 1999 Mar-Apr;211(2):49-52. doi: 10.1055/s-2008-1043763.
Chemotherapy, which has greatly improved the prognosis of children with malignant diseases, is potentially hepatotoxic. Furthermore, there is a risk for viral hepatitis acquired by blood products. In this study we looked for hepatotoxicity and for chronic viral hepatitis during and after chemotherapy in 50 unselected children with malignant diseases. 29 children had been treated for leukemia or lymphoma, 19 for solid tumors, 2 for histiocytosis. All patients had been treated before 1991 and had received blood products not screened for hepatitis C-antibodies. In 18 girls and 32 boys aged 12.3 years (range 6.7-24.5 years) hepatitis B- and hepatitis C-serology and liver function tests were measured during a routine check-up 3.6 years (range 0.5-11.8 years) after the last chemotherapy. Liver function tests during chemotherapy were reviewed retrospectively. During chemotherapy 86% of children showed increased ALT and AST levels, 10% had levels above 500 U/l. At follow up 16 children (32%) had pathological liver function tests, especially slightly increased AST and ALT, 13 of these 16 patients had chronic hepatitis C. In contrast only 2 of 34 patients with normal liver function tests had a viral hepatitis (p = 0.001). Patients with elevation of AST and ALT above 100 U/l during chemotherapy had significantly more often a viral hepatitis than those with normal or slightly elevated aminotransferases. Our study shows that hepatocellular damage is a frequent complication following chemotherapy. However this progresses to chronic liver disease very rarely unless the patient acquired a viral hepatitis. The prevalence of chronic hepatitis C was very high in our patients. As screening of blood products for hepatitis C-antibodies is routinely performed since 1991 this problem is likely to have decreased.
化疗极大地改善了患有恶性疾病儿童的预后，但具有潜在的肝毒性。此外，存在因血液制品感染病毒性肝炎的风险。在本研究中，我们对50例未经挑选的患有恶性疾病的儿童在化疗期间及化疗后进行了肝毒性和慢性病毒性肝炎的检查。29例儿童接受过白血病或淋巴瘤治疗，19例接受过实体瘤治疗，2例接受过组织细胞增多症治疗。所有患者均在1991年前接受治疗，且接受过未筛查丙型肝炎抗体的血液制品。在18名女孩和32名男孩（年龄12.3岁，范围6.7 - 24.5岁）中，在最后一次化疗后3.6年（范围0.5 - 11.8年）的常规检查中检测了乙肝和丙肝血清学及肝功能测试。对化疗期间的肝功能测试进行了回顾性分析。化疗期间，86%的儿童谷丙转氨酶（ALT）和谷草转氨酶（AST）水平升高，10%的儿童这些指标高于500 U/l。随访时，16名儿童（32%）肝功能测试异常，尤其是AST和ALT略有升高，这16名患者中有13例患有慢性丙型肝炎。相比之下，34名肝功能测试正常的患者中只有2例患有病毒性肝炎（p = 0.001）。化疗期间AST和ALT高于100 U/l的患者患病毒性肝炎的频率显著高于转氨酶正常或略有升高的患者。我们的研究表明，肝细胞损伤是化疗后常见的并发症。然而，除非患者感染病毒性肝炎，否则这种情况很少发展为慢性肝病。我们的患者中慢性丙型肝炎的患病率非常高。由于自1991年起已常规对血液制品进行丙肝抗体筛查，这个问题可能已经减少。
