| Objective:To research the effects of high-dose methotrexate chemotherapy on liver function, and to discuss the relevant factors of liver dysfunction.Methods:We retrospectively analyze patients who were diagnosed as osteosarcoma and used high-dose MTX chemotherapy from January 2012 to December 2015 in the First Affiliated Hospital of Guangxi Medical University. Through reviewing the clinical cases, we collected the age, sex, nation, body mass index, chemotherapeutic effect, number of chemotherapy, MTX blood drug concentration, the times of CF delivering, usage of liver-protecting drugs, the index of liver function before and after chemotherapy.Results:1. The incidence of abnormal liver function:In the research,23 patients who use high-dose MTX for approximately seventy times were selected. After chemotherapy, the index of ALT and AST significantly increased (the P value is 0.000 and 0.001 respectively). After chemotherapy, the mean value of GGT also increased (P=0.000), but it’s only slightly higher than the upper limit of the normal range, and had no clinical significance. The mean value of TBIL was higher than pre-chemotherapy which was statistically significant, but its average amount did not exceed the normal range. The mean value of ALP and TBA did not increase compared to anterior treatment(P>0.055). The mean value of ALT increased 65.71% and AST does 51.43%. Among these patients, they would be considered to be liver dysfunction if any liver function indicator was abnormal. The total incidence was 68.57%, including 48 cases and 35.71% in the grade II and above it.2.1nfuential factors:the rising of ALT and AST has a positive correlation on usage of liver-protecting drugs (P value is 0.005 and 0.004 respectively), MTX blood drug concentration at Oh (P value is 0.036 and 0.021 respectively), the serum concentration of MTX at 72h (P value is 0.010 and 0.000 respectively), they have a positive correlation. Among numbers of protecting drugs, two kinds of liver-protecting drugs can reduce the occurrence of liver function related to one kind of drugs, but three kinds were not demonstrated more effectively than the ones. And the sex, age, BMI, number of chemotherapy, CF rescue times, nation, chemotherapeutic effect have nothing to do with liver function abnormal(P>0.05).Conclusion:1.The main indexes of abnormal dysfunction after using HD-MTX in osteosarcoma are ALT and AST, which appear lower incidence. After chemotherapy the incidence of liver dysfunction is 35.71% in the grade II and above it. Using liver protecting drugs ahead of time can reduce the risk of liver damage.2.The serum concentration of MTX at Oh is positively correlated with liver function. We need to monitor the serum concentration closely and reduce the dosage of MTX if necessary.3.The higher the serum concentration of MTX at 72h is, the more obvious of the liver dysfunction is. So we should replenish liquid fully and accelerate drug excretion to relieve the liver damage.4.It is recommended to use 2 kinds of liver protecting drugs in the treatment of MTX. It is demonstrated that the combination of two kinds of the liver-protecting drugs is more effective than only one kind of drugs of the mixture of three different kinds.5. In the present cumulative dose range, the times of chemotherapy has nothing to do with liver function. |
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