Fatty liver and transaminase changes with adjuvant tamoxifen therapy
Fatty liver and transaminase changes with adjuvant tamoxifen therapy
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DOI：
10.1097/01.cad.0000215056.47695.92
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发表时间：
2006-07-01
影响因子：
2.3
通讯作者：
Liu, Tsang-Pai
中科院分区：
文献类型：
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作者：
Liu, Chien-Liang;Huang, Jon-Kway;Liu, Tsang-Pai
我们调查了在辅助他莫昔芬治疗的乳腺癌患者发生脂肪肝所需的时间和血清天冬氨酸转氨酶和丙氨酸转氨酶水平的变化。对早期乳腺癌患者定期进行肝超声检查以检测脂肪肝，并测定血清天冬氨酸和丙氨酸转氨酶水平。结果在使用和不使用辅助他莫昔芬以及化疗的患者组中进行了比较。156名接受他莫昔芬治疗的患者中有82人患脂肪肝，而62名未接受他莫昔芬治疗的患者中有8人患脂肪肝。脂肪肝最早出现在他莫昔芬治疗后3个月，多数病例在2年内被发现。82例患者中有17例在停用他莫昔芬后仍持续48个月。同时接受化疗和他莫昔芬的患者脂肪肝的发生率与单独接受他莫昔芬的患者相同。115例患者有天冬氨酸转氨酶、丙氨酸转氨酶升高或两者同时升高，但只有32例患者的升高幅度具有临床意义。联合化疗和他莫昔芬的患者转氨酶升高的发生率高于单用他莫昔芬的患者。佐剂他莫昔芬增加脂肪肝的发生率，但对天冬氨酸转氨酶和丙氨酸转氨酶的影响很小。脂肪肝最早可在服用他莫昔芬后3个月出现，停药后可持续4年以上。因此，长期随访是必要的。化疗与脂肪肝没有明确的联系，但可能比他莫昔芬引起更大程度的肝细胞损伤。
We investigated the time it took to develop fatty liver and changes in serum aspartate aminotransferase and alanine aminotransferase levels in patients with breast cancer treated with adjuvant tamoxifen. Liver sonography to detect fatty liver and measurement of serum aspartate and alanine aminotransferase levels were performed regularly for patients with early breast cancer. The results were compared in groups of patients with and without adjuvant tamoxifen as well as those on chemotherapy. Eighty-two of 156 patients treated with tamoxifen developed fatty liver, compared with eight of 62 patients not taking it. Fatty liver appeared as early as 3 months after beginning tamoxifen and was detected within 2 years in most cases. It persisted for 48 months after discontinuing tamoxifen in 17 of the 82 patients who developed it. The incidence of fatty liver in patients receiving both chemotherapy and tamoxifen was the same as that in patients receiving tamoxifen alone. While 115 patients had elevations of aspartate aminotransferase, alanine aminotransferase or both, the magnitude of the elevation was clinically significant in only 32 patients. Patients on both chemotherapy and tamoxifen had a higher incidence of elevated transaminases than those on tamoxifen alone. Adjuvant tamoxifen increases the incidence of fatty liver, but has only a minimal effect on aspartate aminotransferase and alanine aminotransferase. Fatty liver may appear as early as 3 months after beginning tamoxifen and may persist for more than 4 years after discontinuing it. Therefore, long-term follow-up is warranted. Chemotherapy is not clearly associated with fatty liver, but may cause a greater degree of hepatocellular damage than does tamoxifen.