Clinical features of liver injury induced by antitumor drugs:An analysis of 56 cases

Zhang HuiJuan; Shi ZuXuan; Zhao LanFang; Gao TianHui; Li Jian

doi:10.3969/j.issn.1001-5256.2019.03.024

Volume 35 Issue 3

Mar. 2019

Turn off MathJax

Article Contents

Abstract

References

Article Navigation > Journal of Clinical Hepatology > 2019 > 35(3): 574-578

PDF( 2150 KB)

Clinical features of liver injury induced by antitumor drugs:An analysis of 56 cases

DOI: 10.3969/j.issn.1001-5256.2019.03.024

Department of Medical Care, The First Affiliated Hospital of Hainan Medical College

Research funding:

Published Date: 2019-03-20

Abstract

Abstract

Objective To investigate the clinical features of drug-induced liver injury ( DILI) caused by antitumor drugs during the treat-ment of malignant tumors. Methods A retrospective analysis was performed for the clinical data of 56 patients who were diagnosed with ma-lignant tumors in Henan Provincial People's Hospital from January 2015 to December 2016 and experienced DILI during the treatment withantitumor drugs, including sex, age, type of primary tumor, hepatotropic virus infection, liver function, type of chemotherapeutics, onsettime of liver injury, application of liver-protecting drugs, and outcome of liver injury. Results Among the 56 patients with DILI caused byantitumor drugs, 30 ( 53. 6%) had hepatocellular injury, and 45 ( 80. 4%) had mild liver injury. FOLFOX, GP/DP, and CHOP were themost common regimens for DILI, and of all 56 patients, 50 ( 89. 3%) had DILI caused by multiple drugs. Platinum-based drugs, anti-microtubule agents, and alkylating agents were the common drugs causing DILI. Of all 56 patients, 35 ( 62. 5%) developed DILI within 1-2 weeks after medication. Conclusion DILI caused by antitumor drugs mainly has a mild degree and hepatocellular injury type is the mostcommon clinical type. Platinum-based antitumor drugs and related chemotherapeutic regimens are the most common drugs for DILI. A com-bination of multiple antitumor drugs is more likely to cause DILI, and patients with such DILI often have a good prognosis.
- antineoplastic agents,
- drug-induced liver injury

FullText(HTML)

References(28)

References

[1] CHEN W, ZHENG R, ZUO T, et al. National cancer incidenceand mortality in China, 2012[J]. Chin J Cancer Res, 2016, 28 (1) :1-11.

[2] CHEN W, ZHENG R, BAADE PD, et al. Cancer statistics in Chi-na, 2015[J]. CA Cancer J Clin, 2016, 66 (2) :115-132.

[3] REN J, ZHOU XN. Development of drug induced liver injury inanti-tumor treatment[J]. Chin J Drug Appl Monit, 2012, 9 (6) :309-313. (in Chinese) 任军, 周心娜.抗肿瘤药物肝损伤研究进展[J].中国药物应用与监测, 2012, 9 (6) :309-313.

[4] VINCENZI B, ARMENTO G, SPALATO CERUSO M, et al, Drug-induced hepatotoxicity in cancer patients-implication for treat-ment[J]. Expert Opin Drug Saf, 2016, 15 (9) :1219-1238.

[5] Drug-induced Liver Disease Study Group, Chinese Society ofHepatology, Chinese Medical Association. Guidelines for themanagement of drug-induced liver injury[J]. J Clin Hepatol, 2015, 31 (11) :1752-1769. (in Chinese) 中华医学会肝病学分会药物性肝病学组.药物性肝损伤诊治指南[J].临床肝胆病杂志, 2015, 31 (11) :1752-1769.

[6] CHEN CW. Research advances in drug-induced liver injuryand existing problems in China[J]. J Clin Hepatol, 2018, 34 (6) :1147-1151. (in Chinese) 陈成伟.药物性肝损伤的研究进展及我国存在的问题[J].临床肝胆病杂志, 2018, 34 (6) :1147-1151.

[7] SHEN T, HUANG X, WANG YY, et al. Current status of epide-miological study on drug-induced liver injury in China[J]. JClin Hepatol, 2018, 34 (6) :1152-1155. (in Chinese) 沈弢, 黄昕, 王誉雅, 等.我国药物性肝损伤流行病学研究现状[J].临床肝胆病杂志, 2018, 34 (6) :1152-1155.

[8] YUAN Y, LI J, LAN L, et al. Analysis of clinical characteristicsamong 245 cases of patients with drug-induced liver damage[J]. Chronic Pathematology J, 2015, 16 (2) :170-172. (inChinese) 袁媛, 李健, 兰玲, 等. 245例药物性肝损伤病例的临床流行病学特征描述[J].慢性病学杂志, 2015, 16 (2) :170-172.

[9] ZHU CW, WANG HN, YUAN JL, et al. Clinical features of drug-induced liver injury:An analysis of 445 cases[J]. J Clin Hepatol, 2018, 34 (2) :354-358. (in Chinese) 朱春雾, 王海南, 袁继丽, 等. 445例药物性肝损伤的临床分析[J].临床肝胆病杂志, 2018, 34 (2) :354-358.

[10] THATISHETTY AV, AGRESTI N, O'BRIEN CB. Chemotherapy-induced hepatotoxicity[J]. Clin Liver Dis, 2013, 17 (4) :671-686.

[11] BAHIRWANI R, REDDY KR. Drug-induced liver injury due tocancer chemotherapeutic agents[J]. Semin Liver Dis, 2014, 34 (2) :162-171.

[12] LEISE MD, POTERUCHA JJ, TALWALKAR JA. Drug-inducedliver injury[J]. Mayo Clin Proc, 2014, 89 (1) :95-106.

[13] YAN SY, FAN JG. Effect of antineoplastic drugs on liver andtheir application in patients with liver diseases[J]. World ClinDrugs, 2011, 32 (9) :513-517. (in Chinese) 颜士岩, 范建高.抗肿瘤药物对肝脏的影响及其在肝病患者中的应用[J].世界临床药物, 2011, 32 (9) :513-517.

[14] HU XY, SUN J, PENG J. New considerations in antiviral thera-py for special populations with chronic hepatitis B[J]. J ClinHepatol, 2016, 32 (11) :2054-2057. (in Chinese) 胡晓云, 孙剑, 彭劼.乙型肝炎特殊人群抗病毒治疗的新认识[J].临床肝胆病杂志, 2016, 32 (11) :2054-2057.

[15] KIM E, YUNE S, HA JM, et al. Hepatitis B virus reactivation dur-ing anticancer chemotherapy in patients with past hepatitis B virusinfection[J]. Hepatogastroenterology, 2014, 61 (134) :1704-1711.

[16] SARIN SK, KUMAR M, LAU GK, et al. Asian-Pacific clinicalpractice guidelines on the management of hepatitis B:A 2015update[J]. Hepatol Int, 2016, 10 (1) :1-98.

[17] WU SX, XU HY, HUANG HC, et al. Clinical analysis of liver in-jury and hepatitis B virus reactivation after chemotherapy inHBsAg-positive patients with malignant tumors[J]. J ClinHepatol, 2016, 32 (1) :110-113. (in Chinese) 吴盛喜, 许鸿鹞, 黄河澄, 等. HBsAg阳性恶性肿瘤患者化疗后肝损伤及HBV再激活的临床分析[J].临床肝胆病杂志, 2016, 32 (1) :110-113.

[18] XU L, TU Z, XU G, et al. Epirubicin directly promotes hepati-tis B virus (HBV) replication in stable HBV-expressing celllines:A novel mechanism of HBV reactivation following anti-cancer chemotherapy[J]. Mol Med Rep, 2014, 9 (4) :1345-1350.

[19] SANAGAWA A, HOTTA Y, KATAOKA T, et al. Hepatitis B in-fection reported with cancer chemotherapy:Analyzing the USFDA adverse event reporting system[J]. Cancer Med, 2018, 7 (6) :2269-2279.

[20] YANG LH, LIU R, ZENG QY, et al. Association of methyle-netetrahydrofolate reductase gene polymorphism in childrenwith acute lymphoblastic leukemia and adverse reaction ofhigh dose methotrexate[J]. J Appl Clin Pediatr, 2012, 27 (6) :440-442. (in Chinese) 杨丽华, 刘茹, 曾其毅, 等.急性淋巴细胞白血病患儿亚甲基四氢叶酸还原酶基因多态性与大剂量甲氨蝶呤不良反应的相关性[J].实用儿科临床杂志, 2012, 27 (6) :440-442.

[21] SCRIPTURE CD, FIGG WD. Drug interactions in cancer thera-py[J]. Nat Rev Cancer, 2006, 6 (7) :546-558.

[22] CAMPEN CJ, VOGEL WH, SHAH PJ. Managing drug interac-tions in cancer therapy:A guide for the advanced practitioner[J]. J Adv Pract Oncol, 2017, 8 (6) :609-620.

[23] TEO YL, HO HK, CHAN A. Formation of reactive metabolitesand management of tyrosine kinase inhibitor-induced hepato-toxicity:A literature review[J]. Expert Opin Drug Metab Toxi-col, 2015, 11 (2) :231-242.

[24] LOU XE, CHEN M, YANG B. Research progress in toxicologyof molecular targeted anticancer drugs[J]. J Zhejiang Univ:Med Sci, 2015, 44 (5) :473-478. (in Chinese) 娄小娥, 陈敏, 杨波.分子靶向抗肿瘤药物的毒性研究进展[J].浙江大学学报:医学版, 2015, 44 (5) :473-478.

[25] PAECH F, BOUITBIR J, KRHENBHL S. Hepatocellular tox-icity associated with tyrosine kinase inhibitors:Mitochondrialdamage and inhibition of glycolysis[J]. Front Pharmacol, 2017, 8:367.

[26] SHAH RR, MORGANROTH J, SHAH DR. Hepatotoxicity of tyro-sine kinase inhibitors:Clinical and regulatory perspectives[J].Drug Saf, 2013, 36 (7) :491-503.

[27] Chinese Society of Infectious Diseases, Chinese Medical As-sociation, Expert Committee for Prevention and Managementof Liver Inflammation. Prevention and management of liver in-flammation:An expert consensus in China[J]. Chin J Clin In-fect Dis, 2014, 7 (1) :4-12. (in Chinese) 中华医学会感染病学分会, 肝脏炎症及其防治专家共识专家委员会.肝脏炎症及其防治专家共识[J].中华临床感染病杂志, 2014, 7 (1) :4-12.

[28] SUN YJ, QI WX, YAO Y. Prevention and treatment of glutathi-one in chemotherapy-induced liver injury[J]. China Cancer, 2015, 24 (1) :57-63. (in Chinese) 孙元珏, 祁伟祥, 姚阳.还原型谷胱甘肽与肿瘤化疗相关性肝损伤的防治[J].中国肿瘤, 2015, 24 (1) :57-63.

Relative Articles

[1]	Yang Xue, Tu RongFang, Yang JinHui. Research advances in drug-induced liver injury[J]. Journal of Clinical Hepatology, 2020, 36(3): 509-513. doi: 10.3969/j.issn.1001-5256.2020.03.006
[2]	Meng CunYing, Liu Jia, Cao Dan, Chen WenJing, Yuan BeiBei, Dong Bing, Ji Dong, Chen YanPing. A case of chronic drug-induced liver injury caused by psoralen decoction[J]. Journal of Clinical Hepatology, 2019, 35(8): 1803-1805. doi: 10.3969/j.issn.1001-5256.2019.08.031
[3]	Lin YunXia, He XiaoBin. Clinical features of drug-induced liver injury and related risk factors[J]. Journal of Clinical Hepatology, 2018, 34(6): 1237-1241. doi: 10.3969/j.issn.1001-5256.2018.06.021
[4]	Huang DeLiang, Dai Wei. A case of acute drug-induced liver injury caused by norethindrone[J]. Journal of Clinical Hepatology, 2018, 34(6): 1294-1295. doi: 10.3969/j.issn.1001-5256.2018.06.033
[5]	Jiang HongLi, Qi YaBin, Zhang Rui, Hu YuLin. Detection rates of autoantibodies in patients with drug-induced liver injury and their clinical significance[J]. Journal of Clinical Hepatology, 2018, 34(1): 164-167. doi: 10.3969/j.issn.1001-5256.2018.01.034
[6]	Chen ChengWei. Research advances in drug-induced liver injury and existing problems in China[J]. Journal of Clinical Hepatology, 2018, 34(6): 1147-1151. doi: 10.3969/j.issn.1001-5256.2018.06.001
[7]	Chen Jun. Drug-induced liver injury caused by Chinese herbal medicine cannot be neglected[J]. Journal of Clinical Hepatology, 2018, 34(6): 1169-1171. doi: 10.3969/j.issn.1001-5256.2018.06.006
[8]	Zhu ChunWu, Wang HaiNan, Yuan JiLi, Peng Yuan, Zhang YaLei, Xue DongYing, Zhang Qin, Liu ChengHai. Clinical features of drug-induced liver injury: an analysis of 445 cases[J]. Journal of Clinical Hepatology, 2018, 34(2): 354-358. doi: 10.3969/j.issn.1001-5256.2018.02.027
[9]	Mao YiMin. Strengthening the scientific research and supervision of drug-induced liver injury based on big data[J]. Journal of Clinical Hepatology, 2018, 34(6): 1166-1168. doi: 10.3969/j.issn.1001-5256.2018.06.005
[10]	Yu LeCheng, Fan Ye, Chen ChengWei. Diagnosis and treatment of drug-induced liver injury[J]. Journal of Clinical Hepatology, 2018, 34(6): 1160-1165. doi: 10.3969/j.issn.1001-5256.2018.06.004
[11]	Shao Shuang, Liu ChunYan, Gao YanHang. Research advances in silybin in treatment of drug-induced liver injury[J]. Journal of Clinical Hepatology, 2017, 33(6): 1179-1182. doi: 10.3969/j.issn.1001-5256.2017.06.035
[12]	Ji ChenHua, Zhang ZhuQing, Wang XiaoYuan, Lu ShuMing. Clinical features of elderly patients with drug-induced liver injury[J]. Journal of Clinical Hepatology, 2017, 33(3): 502-506. doi: 10.3969/j.issn.1001-5256.2017.03.021
[13]	Chou LiXia, Fan ZuoPeng, Liu Ying, Liang Shan, Nie Wei, Lin Wei, Liu YiRong, Zhang Jing, Hu ZhongJie. Application of a modified diagnostic scale in diagnosis of acute drug-induced liver injury[J]. Journal of Clinical Hepatology, 2017, 33(7): 1328-1331. doi: 10.3969/j.issn.1001-5256.2017.07.025
[14]	Yuan Ling, Yang YongGeng, Shen YouXiu, Ma YingCai. Research advances in drug- induced liver injury[J]. Journal of Clinical Hepatology, 2017, 33(2): 375-378. doi: 10.3969/j.issn.1001-5256.2017.02.038
[15]	Liang Shan, Fan ZuoPeng, Nie Wei, Chou LiXia, Chen Jie, Lin Wei, Liu YiRong, Zhang Jing, Hu ZhongJie. Clinical types and features of chronicity of drug-induced liver injury[J]. Journal of Clinical Hepatology, 2016, 32(12): 2356-2359. doi: 10.3969/j.issn.1001-5256.2016.12.025
[16]	Yang Jie, Yao Min, Wang Li, Dong ZhiZhen, Gu JuanJuan, Qiu LiWei, Zhang Wei, Yao DengFu. Synergistic effect of intervention of glypican-3 gene transcription combined with antitumor drugs in inhibiting hepatoma cell proliferation[J]. Journal of Clinical Hepatology, 2016, 32(12): 2347-2352. doi: 10.3969/j.issn.1001-5256.2016.12.023
[17]	Gan Yu, Dong Yi, Zhang HongFei, Xu ZhiQiang, Chen DaWei, Wang LiMin, Wang FuChuan, Yan JianGuo, Zhu ShiShu. Clinical characteristics and outcomes of drug-induced liver injury in children: a study of 184 cases[J]. Journal of Clinical Hepatology, 2015, 31(8): 1244-1247. doi: 10.3969/j.issn.1001-5256.2015.08.015
[18]	Huang ChunYang, Liu YanMin, Huang YunLi, Han Ying, Zhang XiaoDan, Liao HuiYu. Drug-induced liver injury accompanied by autoimmune phenomena: an analysis of clinical characteristics[J]. Journal of Clinical Hepatology, 2015, 31(8): 1303-1306. doi: 10.3969/j.issn.1001-5256.2015.08.029
[19]	Lu Yi, Yu Hui. Discussion on idiosyncratic drug-induced liver injury in children[J]. Journal of Clinical Hepatology, 2015, 31(8): 1215-1217. doi: 10.3969/j.issn.1001-5256.2015.08.008
[20]	Yu LeCheng. Summary of the 2014 Sino-America symposium on drug-induced liver injury and Chinese HepaTox press release conference[J]. Journal of Clinical Hepatology, 2014, 30(7): 706-707. doi: 10.3969/j.issn.1001-5256.2014.07.036

Supplements(0)

Cited By

Cited by

Periodical cited type(21)

1.	于冬冬，韩乐，王建明，杜雪源，晁利芹，王晴晴. 中医药防治化疗药物性肝损伤的研究进展. 中华中医药杂志. 2025(01): 318-321 .
2.	张倩茹，卢颖，张婉婷，杨艳. 某院急性白血病患者药源性肝损伤临床治疗的回顾性分析. 遵义医科大学学报. 2024(04): 401-407 .
3.	朱燃培，桑天庆，谢辉，孙婷婷，屈浩然，李闪闪，郑玉玲. 大柴胡汤在消化系统肿瘤中的研究进展. 中国实验方剂学杂志. 2024(12): 251-260 .
4.	贾茜，张厚莉，卓龙冉，王海敏，邱妮娜，苏凤云. 基于RUCAM分析药物性肝损伤181例的风险因素及临床用药特点. 临床合理用药. 2024(21): 156-159 .
5.	沈子扬，赵良友，吴丹，刘树民，于栋华. 基于肝脏代谢组学探讨桦褐孔菌醇提物肝损伤机制. 长春中医药大学学报. 2024(10): 1095-1101 .
6.	王璐，吕建峰，刘华，丁菁，石爱平. 抗肿瘤药物致肺癌患者药物性肝损伤因素分析. 中国肿瘤外科杂志. 2024(05): 499-503 .
7.	金芬，覃为民，董丹丹，刘生友. 80例药物性肝损伤病例分析. 中国药物滥用防治杂志. 2023(04): 583-587 .
8.	曾潇，韦鸿雁，廖金卯，谭波宇. 不同类别药物致急性药物性肝损伤的临床特征比较及严重程度影响因素分析. 中国医院药学杂志. 2022(03): 313-317 .
9.	李娜. 肺癌患者化疗后药物性肝损伤的临床特点. 中国医药指南. 2022(16): 22-25 .
10.	劳明珠. 异甘草酸镁治疗抗肿瘤药物引起的急性药物性肝损伤临床效果和安全性. 临床合理用药杂志. 2022(17): 84-87 .
11.	王海贺，王璐，李玲，杜金彪. 巴彦淖尔市医院108例抗肿瘤药物不良反应发生情况及特点报告分析. 现代诊断与治疗. 2022(13): 2011-2012+2054 .
12.	张全超，蔡陈超，刘江龙，沈煜楠，阳丽梅. 福建省近十年药物性肝损伤不良反应特征分析. 海峡药学. 2022(12): 155-160 .
13.	张佳佳，席明名. 紫杉醇联合卡铂静脉化疗相关肝损伤93例临床特点及治疗分析. 中国实用医刊. 2022(24): 1-5 .
14.	胡玥，吴存恩，邵杰，张力. 益气健脾解毒方治疗中晚期胃癌疗效及对免疫功能和不良反应的影响. 现代中西医结合杂志. 2022(24): 3463-3467 .
15.	王晓艳，李伟霞，张辉，张明亮，陈盼盼，贾文汇，牛璐，王炎，唐进法. 复方甘草酸苷防治药物性肝损伤有效性与安全性的Meta分析. 实用中医内科杂志. 2021(01): 22-27 .
16.	王琳，陈希，罗晓枫，蔡爽. 保肝药物预防化疗所致药物性肝损伤的Meta分析. 肿瘤药学. 2021(01): 22-30 .
17.	洪佳妮，傅瑞春，黄炳川. 116例药物性肝损伤的临床特征及相关因素分析. 肝脏. 2021(04): 370-374 .
18.	董艳. 异甘草酸镁治疗抗肿瘤药物致急性药物性肝损伤的临床疗效. 临床合理用药杂志. 2021(30): 120-122 .
19.	张梦凡. 张林军主任医师抗肿瘤药物治疗肝损伤的经验. 光明中医. 2020(15): 2304-2306 .
20.	王晓艳，李伟霞，张辉，张明亮，陈盼盼，贾文汇，牛璐，王炎，唐进法. 五酯胶囊(片/滴丸)防治药物性肝损伤有效性与安全性的Meta分析. 实用中医内科杂志. 2020(12): 9-13 .
21.	卢佳姝. 保肝药预防抗肿瘤药物肝损伤的用药合理性分析. 中国处方药. 2019(11): 28-29 .

Other cited types(4)

Proportional views

Proportional views

通讯作者: 陈斌, bchen63@163.com

1.
沈阳化工大学材料科学与工程学院沈阳 110142

Get Citation

PDF

XML

Article Metrics

Article views (1828) PDF downloads(352)

Clinical features of liver injury induced by antitumor drugs:An analysis of 56 cases

DOI: 10.3969/j.issn.1001-5256.2019.03.024