Screening of Optimal Liver Protection Scheme for Acute Liver Injury Induced by Transarterial Chemoembolization in Primary Liver Cancer

doi:10.12114/j.issn.1007-9572.2019.00.022

Abstract

Abstract: Background　There is no clear guidelines and medication standards at home and abroad for liver protection treatment of acute liver injury（ALI） caused by transarterial chemoembolization（TACE）．Pharmacoeconomic method was used to screen out optimal liver protection program for ALI caused by TACE，which can not only enable patients to obtain reasonable and effective liver protection treatment，reduce the pain caused by ALI，but also reduce the economic burden of patients.Objective　To carry out cost-efficacy analysis （CEA） of different liver protection schemes for primary liver cancer（PLC） after TACE by using pharmacoeconomic methods，providing a reference for the selection of liver protection therapy after TACE.Methods　A total of 180 patients with PLC admitted to the Fourth Hospital of Hebei Medical University from October 2013 to October 2016 were selected and divided into 6 groups （A，B，C，D，E，F） with 30 cases in each group.Group A received protectant for hepatocyte membrane repair + detoxification.Group B received protectant for hepatocyte membrane repair +anti-inflammatory drugs.Group C received protectant for hepatocyte membrane repair +cholagogic drugs.Group D received detoxification+ anti-inflammatory drugs.Group E received detoxification+ cholagogic drugs.Group F received anti-inflammatory+ cholagogic drugs.Clinical efficacy and cost-efficacy ratio（CER） were compared between the six groups.Results　There were significant differences in the total efficacy rate between the six groups on the 4th and 6th day after interventional therapy （χ2=18.311，P=0.003；χ2=23.563，P<0.001）．The CER of the 6 groups were 6.38，9.38，10.05，7.70，9.86 and 9.26，respectively，on the 4th day after interventional operation.Group A，as the control group，had the lowest cost.The incremental CER of other five groups were 20.19，76.30，11.09，52.95 and 13.99，respectively.The CER of the sensitivity analysis of the 6 groups on the 4th day after intervention were 5.74，8.44，9.05，6.93，8.88 and 8.34，respectively；group A，as the control group，had the lowest cost，with incremental CER of 18.17，68.67，9.98，47.65 and 12.59，respectively in other five groups.The CER of the 6 groups were 7.48，10.79，10.61，9.95，10.93 and 13.43，respectively，on the 6th day after interventional operation.Group A，as the control group，had the lowest cost.The incremental CER of other five groups were as follows：21.64，28.59，19.41，0 and 32.98 respectively.The CER of sensitivity analysis of the 6 groups were 6.74，9.71，9.55，8.96，9.84 and 12.09，respectively；group A，as the control group，had the lowest cost.The incremental CER were 19.47，25.73，17.46，0 and 29.68，respectively in other five groups.Conclusion　The use of hepatoprotective drugs after TACE can effectively improve the level of liver biochemical indexes in patients.In terms of efficacy，anti-inflammatory+cholagogic drugs are the best.In terms of pharmacoeconomics，anti-inflammatory+ detoxification are the most economical and reasonable option.

Key words: Liver neoplasms, Transarterial chemoembolization, Liver injury, Treatment outcome, Cost-benefit analysis

摘要： 背景　针对经导管肝动脉灌注化疗栓塞（TACE）所致急性肝损伤（ALI）的保肝治疗，目前国内外无明确指南及用药标准。应用药物经济学方法筛选出针对TACE所致ALI的最优保肝方案，不仅能使患者得到合理、有效的保肝治疗，减少由于ALI带来的病痛，还能减轻患者的经济负担。目的　运用药物经济学方法对原发性肝癌（PLC）TACE术后不同保肝方案进行成本-效果分析（CEA），为TACE术后保肝治疗的选择提供参考依据。方法　选取2013年10月—2016年10月河北医科大学第四医院收治的PLC患者180例，采用完全随机化分组将患者分为六组（A、B、C、D、E、F组），每组各30例。其中A组给予肝细胞膜修复保护剂+解毒类、B组给予肝细胞膜修复保护剂+抗炎类、C组给予肝细胞膜修复保护剂+利胆类、D组给予解毒类+抗炎类、E组给予解毒类+利胆类、F组给予抗炎类+利胆类。对比六组患者临床疗效及成本-效果比（CER）。结果　六组患者介入术后第4天、第6天总有效率比较，差异均有统计学意义（χ2=18.311，P=0.003；χ2=23.563，P<0.001）。六组患者介入术后第4天CER依次为6.38、9.38、10.05、7.70、9.86、9.26；A组患者成本最低，增量CER依次为20.19、76.30、11.09、52.95、13.99；六组患者介入术后第4天敏感度分析，CER依次为5.74、8.44、9.05、6.93、8.88、8.34；A组患者成本最低，增量CER依次为18.17、68.67、9.98、47.65、12.59。六组患者介入术后第6天CER依次为7.48、10.79、10.61、9.95、10.93、13.43；A组患者成本最低，增量CER依次为21.64、28.59、19.41、0、32.98；六组患者介入术后第6天敏感度分析，CER依次为6.74、9.71、9.55、8.96、9.84、12.09；A组患者成本最低，增量CER依次为19.47、25.73、17.46、0、29.68。结论　TACE术后应用保肝药物可有效改善患者肝生化指标水平，从疗效方面考虑抗炎类+利胆类效果最好，从药物经济学方面考虑抗炎类+解毒类最经济、合理。

关键词: 肝肿瘤, 肝动脉化疗栓塞, 肝损伤, 治疗结果, 费用效益分析

WU Zhonglin,WU Yongchao,RONG Xiaocui, et al. Screening of Optimal Liver Protection Scheme for Acute Liver Injury Induced by Transarterial Chemoembolization in Primary Liver Cancer　[J]. Chinese General Practice, 2019, 22(26): 3159-3164. DOI: 10.12114/j.issn.1007-9572.2019.00.022.
武中林,吴勇超,荣小翠等. 原发性肝癌经导管肝动脉灌注化疗栓塞所致急性肝损伤的最优保肝方案筛选[J]. 中国全科医学, 2019, 22(26): 3159-3164. DOI: 10.12114/j.issn.1007-9572.2019.00.022.

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