Kedarisetty Chandan K, Bal Sipra, Parida Subhashree, Jain Mayank, Bhadoria Ajeet S, Varghese Joy, Venkataraman Jayanthi
Dept of Hepatology, Sri Ramachandra Institute of Higher Education and Research, Chennai, India.
Dept of Hepatology, Gleneagles Global Health City, Chennai, India.
J Clin Exp Hepatol. 2021 May-Jun;11(3):299-304. doi: 10.1016/j.jceh.2020.10.007. Epub 2020 Oct 27.
Transarterial chemoembolization (TACE) is the most common locoregional therapy for hepatocellular carcinoma (HCC). Postembolization syndrome is not an uncommon complication. At present, there is no specific treatment for management of this complication. We aimed to study the role of N-acetyl cysteine (NAC), an antioxidant, in management of this complication.
In a prospective observational study, consecutive patients with HCC undergoing TACE from January 2016 to January 2017 were included. Patients with postembolization syndrome, defined as an elevation of transaminase levels more than 3-4 times the upper limit of normal, were administered intravenous NAC for 72 h (150 mg/kg for 1 h, then 12.5 mg/kg/h for 4 h, and continuous infusion 6.25 mg/h for the remaining 67 h). The other group received only supportive standard of care. The primary end point was reduction in post-TACE transaminitis.
Of 112 patients with HCC, 53 (47.3%) received NAC. The majority were cirrhotics in both the groups. Both groups were well matched in demographic, laboratory, and tumor characteristics. In the NAC group, there was significant reduction in Aspartate transaminase (AST) and Alanine transaminase (ALT) levels from day 1 to day 3 (p = 0.000) compared with the non-NAC group, with no significant change in bilirubin or international normalized ratio levels. The duration of hospital stay was similar in both the groups. None had any major adverse events to NAC.
This is a prospective, single-center experience, showing that early initiation of N-acetyl cysteine in those with post-TACE embolization syndrome reduces the transaminase level significantly.
经动脉化疗栓塞术（TACE）是肝细胞癌（HCC）最常见的局部区域治疗方法。栓塞后综合征是一种常见的并发症。目前，对于该并发症的处理尚无特效治疗方法。我们旨在研究抗氧化剂N-乙酰半胱氨酸（NAC）在处理该并发症中的作用。
在一项前瞻性观察性研究中，纳入了2016年1月至2017年1月连续接受TACE治疗的HCC患者。将栓塞后综合征定义为转氨酶水平升高超过正常上限3 - 4倍的患者，静脉给予NAC 72小时（150 mg/kg，持续1小时，然后12.5 mg/kg/h持续4小时，剩余67小时以6.25 mg/h持续输注）。另一组仅接受支持性标准治疗。主要终点是TACE术后转氨酶升高情况的改善。
112例HCC患者中，53例（47.3%）接受了NAC治疗。两组中大多数患者为肝硬化患者。两组在人口统计学、实验室检查和肿瘤特征方面匹配良好。与未接受NAC治疗的组相比，NAC组从第1天到第3天天门冬氨酸转氨酶（AST）和丙氨酸转氨酶（ALT）水平显著降低（p = 0.000），胆红素或国际标准化比值水平无显著变化。两组住院时间相似。无人对NAC有任何严重不良事件。
这是一项前瞻性单中心研究经验，表明对于TACE栓塞后综合征患者早期使用N-乙酰半胱氨酸可显著降低转氨酶水平。
