一项病例对照研究：替比夫定期间抢先抗病毒治疗中晚期接

StephenW

Original Article
Significant renoprotective effect of telbivudine during preemptive antiviral therapy in advanced liver cancer patients receiving cisplatin-based chemotherapy: a case–control study

Posted online on October 6, 2014. (doi:10.3109/00365521.2014.962604)

   
Chih-Lang Lin, Rong-Nan Chien, Charisse Yeh, Chao-Wei Hsu, Ming-Ling Chang, Yi-Cheng Chen, and Chau-Ting Yeh
1Liver Research Unit, Keelung Chang Gung Memorial Hospital, Keelung , Taiwan
2Graduate Institute of Clinical Medical Science, Chang Gung University College of Medicine, Taoyuan , Taiwan
3Flintridge Sacred Heart Academy, La Canada Flintridge, California , USA
4Liver Research Center, Chang Gung Memorial Hospital, Taipei, Taiwan
Correspondence: Chih-Lang Lin, MD PhD, Department of Internal Medicine, Division of Gastroenterology, Chang Gung Memorial Hospital,
Keelung, 222 Mai-Chin Road, Keelung, Taiwan. +886 2 24313131 ext 3171. +886 2 24335342. [email protected] and Chau-Ting Yeh, MD PhD, Liver Research Center, Chang Gung Memorial Hospital, 199 Tung Hwa North Road, Taipei , Taiwan. +886 3 3281200 ext 8129. +886 3 3282824. [email protected]


Abstract

Objective. Cisplatin is a known nephrotoxic agent requiring vigorous hydration before use. However, aggressive hydration could be life-threatening. Therefore, in cirrhotic patients with advanced hepatocellular carcinoma (HCC) under cisplatin-based chemotherapy, the risk of nephrotoxicity increased. Because previous studies showed that long-term telbivudine treatment improved renal function in chronic hepatitis B virus (HBV) infected patients, we conducted a case–control study to evaluate the clinical outcome of telbivudine preemptive therapy in HBV-related advanced HCC patients treated by combination chemotherapy comprising 5-fluorouracil, mitoxantrone and cisplatin (FMP). Material and methods. From June 2007 to March 2012, 60 patients with HBV-related advanced HCC, all receiving the same FMP chemotherapy protocol, were enrolled. Of them, 20 did not receive any antiviral therapy, whereas the remaining 40 patients (sex and age matched) received telbivudine preemptive therapy. Results. Progressive decrease of aminotransferase levels (p < 0.05) and progressive increase of viral clearance rates (p < 0.001) were found in telbivudine-treated group. No drug resistance developed during the course of treatment. When compared with non-antiviral-treated patients, a significantly higher post-therapeutic estimated glomerular filtration rate (eGFR) was found in the telbivudine-treated group (p < 0.001). In patients with initial eGFR >100 ml/min (n = 34), the median overall survival was significantly longer in the telbivudine-treated group (12.1 vs. 4.9 months; p = 0.042). Conclusion. Preemptive use of telbivudine significantly prevented eGFR deterioration caused by cisplatin-based chemotherapy in HBV-related advanced HCC. In patients with initially sufficient eGFR level, telbivudine treatment was associated with a longer overall survival.
Keywords
hepatocellular carcinoma, hepatitis B, fluorouracil, estimated glomerular filtration rate, mitoxantrone



Read More: http://informahealthcare.com/doi/abs/10.3109/00365521.2014.962604

StephenW

原创文章
一项病例对照研究：替比夫定期间抢先抗病毒治疗中晚期接受顺铂为基础的化疗的肝癌患者显著肾脏保护作用

线上发表于10月6日，2014（DOI：10.3109/00365521.2014.962604）

   
志郎琳，简荣南，查里斯叶，朝魏许，明灵畅，易程晨，和洲，叶婷
1Liver研究单位，基隆长庚医院，基隆，台湾
临床医学科学2Graduate研究所，医学长庚大学，桃园，台湾
3Flintridge圣心书院，香格里拉加拿大Flintridge，加利福尼亚州，美国
4Liver研究中心，长庚医院，台北，台湾
通讯地址：致郎琳，医学博士，内科，消化内科，长庚医院的科部，
基隆，222迈金路，基隆，台湾。 +886224313131转3171.886224335342. [email protected]和筹庭叶，医学博士，肝病研究中心，长庚医院，东北华路199号，台北，台湾。 88633281200分机8129.88633282824. [email protected]


摘要

目的。顺铂是一种已知的肾毒性剂，需要在使用前轰轰烈烈的水化。然而，积极的水化可能危及生命。因此，肝硬化晚期肝细胞癌（HCC）下顺铂为基础的化疗，肾毒性的危险性增加。因为以往的研究表明，长期替比夫定治疗改善肾功能的慢性乙型肝炎病毒（HBV）感染的患者，我们进行了病例对照研究，以评估抢先替比夫定治疗由结合治疗乙肝相关肝癌晚期患者的临床结果化疗包括5 - 氟脲嘧啶，米托蒽醌和氯氨铂（FMP）。材料和方法。从2007年6月至2012年3月，60例HBV相关的肝癌晚期，所有接收相同的FMP化疗方案，被纳入。其中，20并没有收到任何抗病毒治疗，而其余40例（性别，年龄相匹配）接受替比夫定先发制人治疗。结果。转氨酶水平逐渐降低（P <0.05），病毒清除率（P <0.001）的逐步增加被发现在替比夫定治疗组。治疗过程中没有耐药性的发展。当与非抗病毒治疗的患者相比，一个显著高后治疗估计肾小球滤过率（eGFR）发现了替比夫定治疗组（P <0.001）。患者最初的eGFR> 100毫升/分钟（N=34），中位总生存期为显著时间越长，替比夫定治疗组（12.1对比4.9个月，P =0.042）。结论。抢先使用替比夫定的显著预防HBV相关肝癌晚期引起的以顺铂为基础的化疗方案的eGFR恶化。患者最初足够的表皮生长因子受体的水平，替比夫定治疗与延长了生存期有关。
关键词
肝癌，乙肝，氟尿嘧啶，估计肾小球滤过率，米托蒽醌



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