帕洛诺司琼联合地塞米松预防化疗所致恶心呕吐失败的危险因素探索
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篇名: 帕洛诺司琼联合地塞米松预防化疗所致恶心呕吐失败的危险因素探索
TITLE: Exploration of Risk Factors for Prevention Failure of Chemotherapy-related Nausea and Vomiting with Palonosetron Combined with Dexamethasone
摘要: 目的:探索可能导致帕洛诺司琼联合地塞米松预防化疗所致恶心呕吐(CINV)失败的危险因素,为合理选择和使用预防CINV的药物提供参考。方法:采用回顾性病例对照研究,以某三级肿瘤专科医院2016-2020年使用帕洛诺司琼联合地塞米松预防CINV的患者871例次为对象,统计患者人口学资料、生活习惯、病史资料、检查信息、治疗信息等32项相关资料作为变量。采用单因素回归、多因素回归、似然比向前或向后逐步回归相结合,对各因素进行综合、多次筛选;将逐步回归筛选出的符合标准的目标因素纳入多因素Logistic回归分析,并使用受试者工作特征曲线(ROC)对回归模型进行评价。结果:多因素Logistic回归模型拟合情况良好(ROC中全因素曲线下面积为0.83,筛选后为0.82),共发现具有统计学意义的独立影响因素15项,其中独立危险因素12项,包括营养情况差[OR=2.11,95%CI(1.05,4.22),P=0.036]、有胃肠道疾病史[OR=2.76,95%CI(1.87,4.07),P<0.001]、电解质水平异常[OR=2.54,95%CI(1.74,3.69),P<0.001]、化疗前24h发生过恶心呕吐[OR=8.47,95%CI(3.28,21.91),P<0.001]、有化疗呕吐史[OR=3.20,95%CI(2.18,4.71),P<0.001]、化疗方案致吐风险等级高[OR=3.16,95%CI(2.38,4.20),P<0.001]、应用阿片类联合非甾体类抗炎药[OR=4.18,95%CI(2.06,8.49),P<0.001]、应用其他刺激肠胃的药物[OR=2.49,95%CI(1.28,4.83),P=0.007]、有手术史[OR=1.88,95%CI(1.34,2.63),P<0.001]、白蛋白水平高[OR=1.05,95%CI(1.01,1.08),P=0.015]、单次化疗多日[OR=1.69,95%CI(1.11,2.56),P=0.014]、应用阿片类止痛药[OR=1.71,95%CI(1.15,2.53),P=0.007];独立保护因素3项,包括确诊时间久[OR=0.65,95%CI(0.46,0.93),P=0.019]、非首次化疗[OR=0.52,95%CI(0.33,0.83),P=0.006]、多药联合化疗[OR=0.55,95%CI(0.34,0.90),P=0.018]。结论:单次长时间化疗、应用高致吐风险等级的化疗方案、有化疗呕吐史、有胃肠道疾病史、化疗前24h出现过恶心呕吐、有手术史、确诊1年以内、首次化疗、应用阿片类药物、应用5-羟色胺3再摄取抑制剂、营养不良、电解质紊乱的患者在采用帕洛诺司琼联合地塞米松预防CINV时更易失败。
ABSTRACT: OBJECTIVE:To explore t he risk factors that may lead to the ineff ectiveness of using palonosetron combined with dexamethasone to prevent chemotherapy-induced nausea and vomiting (CINV),and to provide a reference for the rational choice and use of antiemetic drugs. METHODS :In a retrospective case-control study ,871 patients who used palonosetron combined with dexamethasone to prevent CINV in a tertiary cancer hospital from 2016 to 2020 were selected as the object. Totally 32 related data such as demographic data ,living habits ,medical history ,examination information and treatment information were counted as variables. Combined with single factor regression ,multi-factor regression, likelihood ratio forward or backward stepwise 163.com regression were used to comprehensively screen the factors for many times. The standard target factors screened by stepwise E-mail:kongtiandong@126.com regression were included in the multivariate Logistic regression analysis,and the regression model was evaluated by the ROC c urve. RESULTS :The multivariate Logistic regression model fitted well(AUC in ROC was 0.83,but 0.82 after screening ). The results showed that there were 15 statistically significant independent influential factors ,including 12 independent risk factors ,ie. poor nutritional status (OR=2.11,95%CI(1.05,4.22),P=0.036), history of gastrointestinal disease (OR=2.76,95%CI(1.87,4.07),P<0.001),abnormal electrolyte level (OR=2.54,95%CI (1.74,3.69),P<0.001),nausea and vomiting 24 h before chemotherapy (OR=8.47,95%CI(3.28,21.91),P<0.001),history of chemotherapy-induced vomiting (OR=3.20,95% CI (2.18,4.71),P<0.001),high risk level of vomiting caused by chemotherapy(OR=3.16,95%CI(2.38,4.20),P<0.001),application of opioid combined with non-steroidal analgesics (OR= 4.18,95%CI(2.06,8.49),P<0.001),the use of other drugs that stimulate the intestine and stomach (OR=2.49,95%CI(1.28, 4.83),P=0.007),history of surgery (OR=1.88,95%CI(1.34,2.63),P<0.001),high level of albumin (OR=1.05,95%CI (1.01,1.08),P=0.015),multiple days of single chemotherapy (OR=1.69,95%CI(1.11,2.56),P=0.014),and opioid analgesia medicine (OR=1.71,95%CI(1.15,2.53),P=0.007);and the following 3 independent protective factors included long time of diagnosis (OR=0.65,95%CI(0.46,0.93),P=0.019),non-first chemotherapy (OR=0.52,95%CI(0.33,0.83),P= 0.006),and drugs combined chemotherapy (OR=0.55,95%CI(0.34,0.90),P=0.018). CONCLUSIONS :Patients with the following conditions are more likely to experience CINV prevention ineffectiveness ,ie. single long-term chemotherapy ,application of chemotherapy plan with a higher risk of emesis ,history of chemotherapy-induced vomiting ,history of gastrointestinal diseases , nausea and vomiting 24 hours prior to chemotherapy ,history of surgery ,within 1 year of diagnosis ,chemotherapy for the first time,use of opioids ,use of 5-HT3 reuptake inhibitors ,malnutrition and electrolyte disorders.
期刊: 2021年第32卷第21期
作者: 孙博,刘丹娜,刘勋,张二锋,马换青,赵晓丽,陈露,孔天东
AUTHORS: SUN Bo,LIU Danna ,LIU Xun,ZHANG Erfeng ,MA Huanqing ,ZHAO Xiaoli,CHEN Lu,KONG Tiandong
关键字: 帕洛诺司琼;地塞米松;化疗相关恶心呕吐;预防失败;危险因素
KEYWORDS: Palonosetron;Dexamethasone;CINV;Prevention failure ;Risk factors
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