地塞米松和乙酰半胱氨酸联合预防肝癌经导管动脉化疗栓塞术后栓塞后综合征的疗效。
Efficacy of dexamethasone and N-acetylcysteine combination in preventing post-embolization syndrome after transarterial chemoembolization in hepatocellular carcinoma.
机构信息
Department of Internal Medicine, Navamindradhiraj University, Bangkok 10300, Thailand.
Department of Radiology, Navamindradhiraj University, Bangkok 10300, Thailand.
出版信息
World J Gastroenterol. 2023 Feb 7;29(5):890-903. doi: 10.3748/wjg.v29.i5.890.
BACKGROUND
Conventional transarterial chemoembolization (cTACE) is the current standard treatment for intermediate-stage hepatocellular carcinoma (HCC). Post-embolization syndrome (PES) is complex clinical syndrome that presents as fever, abdominal pain, nausea, and vomiting. Either dexamethasone (DEXA) or N-acetylcysteine (NAC) is used to prevent PES; however, the synergistic effect of their combined therapy for preventing PES and liver decompensation has not been determined.
AIM
To evaluate the efficacy of DEXA and NAC combination in preventing PES and liver decompensation after cTACE.
METHODS
Patients with Barcelona Clinic Liver Cancer stage A or B HCC who were scheduled for TACE were prospectively enrolled. All patients were randomly stratified to receive NAC and DEXA or placebo. The dual therapy (NAC + DEXA) group received intravenous administration of 10 mg DEXA every 12 h, NAC 24 h prior to cTACE (150 mg/kg/h for 1 h followed by 12.5 mg/kg/h for 4 h), and a continuous infusion of 6.25 mg/h NAC plus 4 mg DEXA every 12 h for 48 h after cTACE. The placebo group received an infusion of 5% glucose solution until 48 h after procedure. PES was defined by South West Oncology Group toxicity code grading of more than 2 that was calculated using incidence of fever, nausea, vomiting, and pain.
RESULTS
One-hundred patients were enrolled with 50 patients in each group. Incidence of PES was significantly lower in the NAC + DEXA group compared with in the placebo group (6% 80%; < 0.001). Multivariate analysis showed that the dual treatment is a protective strategic therapy against PES development [odds ratio (OR) = 0.04; 95% confidence interval (CI): 0.01-0.20; < 0.001). Seven (14%) patients in the placebo group, but none in the NAC + DEXA group, developed post-TACE liver decompensation. A dynamic change in Albumin-Bilirubin score of more than 0.5 point was found to be a risk factor for post-TACE liver decompensation (OR = 42.77; 95%CI: 1.01-1810; = 0.049).
CONCLUSION
Intravenous NAC + DEXA administration ameliorated the occurrence of PES event after cTACE in patients with intermediate-stage HCC.
背景
传统的经动脉化疗栓塞术（cTACE）是目前治疗中期肝细胞癌（HCC）的标准治疗方法。栓塞后综合征（PES）是一种复杂的临床综合征，表现为发热、腹痛、恶心和呕吐。地塞米松（DEXA）或 N-乙酰半胱氨酸（NAC）用于预防 PES；然而，其联合治疗预防 PES 和肝功能失代偿的协同作用尚未确定。
目的
评估 DEXA 和 NAC 联合预防 cTACE 后 PES 和肝功能失代偿的疗效。
方法
前瞻性纳入巴塞罗那临床肝癌分期 A 或 B HCC 并计划行 TACE 的患者。所有患者均随机分层接受 NAC 和 DEXA 或安慰剂治疗。联合治疗（NAC+DEXA）组患者于 TACE 前 24 小时内静脉给予 10mg DEXA，每 12 小时一次，NAC 150mg/kg/h 持续 1 小时，然后 12.5mg/kg/h 持续 4 小时，cTACE 后 48 小时内持续静脉滴注 6.25mg/h NAC 加 4mg DEXA，每 12 小时一次。安慰剂组患者在术后 48 小时内输注 5%葡萄糖溶液。根据西南肿瘤协作组毒性分级标准，超过 2 级的发热、恶心、呕吐和疼痛发生率定义为 PES。
结果
共纳入 100 例患者，每组 50 例。与安慰剂组相比，NAC+DEXA 组 PES 发生率显著降低（6%比 80%；<0.001）。多因素分析显示，联合治疗是预防 PES 发生的保护策略[比值比（OR）=0.04；95%置信区间（CI）：0.01-0.20；<0.001]。安慰剂组有 7 例（14%）患者发生 TACE 后肝功能失代偿，而 NAC+DEXA 组无一例发生。发现白蛋白-胆红素评分动态变化超过 0.5 分是 TACE 后肝功能失代偿的危险因素（OR=42.77；95%CI：1.01-1810；=0.049）。
结论
静脉内给予 NAC+DEXA 可改善中期 HCC 患者 cTACE 后 PES 事件的发生。
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