摘要
目的 探讨经含奥沙利铂方案化疗的脾肾阳虚证和非脾肾阳虚证结直肠癌患者不良反应发生情况的差异。方法 回顾性收集首都医科大学附属北京中医医院电子病历数据库2009年1月1日至2022年12月31日诊断为结直肠癌的483例患者病历资料,根据其辨证分型将患者分为脾肾阳虚证组130例、非脾肾阳虚证组353例。比较两组患者完成2、4、6个周期及>6个周期化疗后的不良反应(消化道反应、肝功能损伤、骨髓抑制、周围神经毒性)的发生情况,并运用单因素和多因素Logistic回归分析完成2、4、6个周期及>6个周期的含奥沙利铂方案化疗的结直肠癌患者年龄、性别、饮酒史、原发肿瘤部位、病理分化程度、肿瘤分期、化疗疗程及辨证类型对其消化道反应、肝功能损伤、骨髓抑制、周围神经毒性发生情况的影响。结果 两组患者完成2、4、6个周期及>6个周期化疗后消化道反应发生情况差异均有统计学意义(P<0.01),脾肾阳虚证组患者消化道反应发生情况较非脾肾阳虚证组患者更严重(P<0.01);两组患者的肝功能损伤及骨髓抑制情况差异均无统计学意义(P>0.05);周围神经毒性发生情况在化疗完成2个周期(P=0.044)、4个周期(P=0.002)及>6个周期(P<0.001)差异均有统计学意义,脾肾阳虚证组患者周围神经毒性发生率较非脾肾阳虚证组患者更高(P<0.05)。单因素分析结果显示,女性、肿瘤Ⅲ期及化疗≥6个周期的患者骨髓抑制发生率更高(P<0.05),脾肾阳虚证患者的消化道反应发生率更高(P<0.001),既往有饮酒史、肿瘤Ⅳ期及化疗≥6个周期的患者肝功能损伤发生率更高(P<0.05),肿瘤Ⅲ期、化疗≥6个周期及脾肾阳虚证的患者周围神经毒性发生率更高(P<0.05)。多因素分析结果显示,骨髓抑制发生的危险因素为化疗≥6个周期(P=0.001),消化道反应发生的危险因素为脾肾阳虚证(P<0.001),肝功能损伤发生的危险因素为肿瘤分期Ⅳ期(P=0.001)及脾肾阳虚证(P=0.039),各变量与周围神经毒性的发生均无显著相关性。结论 脾肾阳虚证较非脾肾阳虚证结直肠癌患者应用含奥沙利铂方案化疗后发生消化道反应、周围神经毒性的风险更高。
Objective To compare the difference in adverse reactions after oxaliplatin-containing chemotherapy between colorectal cancer patients with or without spleen-kidney yang deficiency syndrome.Methods A retrospective study was conducted using the electronic medical records of Beijing Hospital of Traditional Chinese Medicine,Capital Medical University.A total of 483 colorectal cancer patients from January 1,2009 to December 31,2022 were selected.Patients were divided into two groups based on their syndrome types,that was spleen-kidney yang deficiency syndrome(SKYDS)group(130 cases)and non-SKYDS group(353 cases).The incidence of adverse reactions including gastrointestinal reactions,liver damage,bone marrow suppression,and peripheral neurotoxicity after completing 2,4,6,and more than 6 cycles of chemotherapy was compared between the two groups.Univariate and multivariate logistic regression analyses were used to analyze the associations of age,gender,alcohol history,primary tumor location,tumor differentiation,tumor staging,chemotherapy courses,and syndrome types with the occurrence of gastrointestinal adverse reactions,liver function damage,bone marrow suppression and peripheral neurotoxicity in colorectal cancer patients who have completed 2,4,6 and more than 6 cycles of oxaliplatin-containing chemotherapy.Results There were significant differences in the occurrence of gastrointestinal reactions after completing 2,4,6 and more than 6 cycles of chemotherapy between the two groups(P<0.01),with much more severe conditions in SKYDS group than non-SKYDS group(P<0.01).There was no significant difference in liver function damage and bone marrow suppression between groups(P>0.05).There were statistically significant differences in the occurrence of peripheral neurotoxicity after completion of 2 cycles(P=0.044),4 cycles(P=0.002)and more than 6 cycles(P<0.001)of chemothe-rapy,with higher rate in SKYDS group than the non-SKYDS group(P<0.05).Univariate analysis showed that female,patients with stageⅢtumors and patients having completed≥6 cycles of chemotherapy had a higher incidence of bone marrow suppression(P<0.05),and patients with SKYDS had a higher incidence of gastrointestinal reactions(P<0.001).Patients with a history of drinking,stageⅣcancer,and≥6 cycles of chemotherapy had a higher incidence of liver function injury(P<0.05).Patients with stageⅢcancer,≥6 cycles of chemotherapy,and SKYDS had a higher incidence of peripheral neurotoxicity(P<0.05).Multivariate analysis showed that the risk factor for bone marrow suppression was chemotherapy≥6 cycles(P=0.001),and SKYDS was the risk factor for gastrointestinal reaction(P<0.001).The risk factor for liver function damage was tumor stageⅣ(P=0.001)and SKYDS(P=0.039).All variables had no significant correlation with the occurrence of peripheral neurotoxicity.Conclusion For colorectal cancer patients,being diagnosed with SKYDS is a risk factor for developing gastrointestinal adverse reactions and peripheral neurotoxicity following chemotherapy with an oxaliplatin-based regimen.
作者
力一凡
赵依庞
韩博远
刘奕萱
邢思璇
杨雯靖
张青
LI Yifan;ZHAO Yipang;HAN Boyuan;LIU Yixuan;XING Sixuan;YANG Wenjing;ZHANG Qing(Beijing University of Chinese Medicine,Beijing,100029;Beijing Hospital of Traditional Chinese Medicine,Capital Medical University)
出处
《中医杂志》
CSCD
北大核心
2024年第19期2010-2017,共8页
Journal of Traditional Chinese Medicine
基金
北京市医院管理中心青年人才培养“青苗”计划(QML20231004)
恩施州科技计划研究与开发项目(JCY2019000040)。
关键词
结直肠癌
奥沙利铂
不良反应
脾肾阳虚证
回顾性研究
colorectal cancer
oxaliplatin
adverse reactions
spleen-kidney yang deficiency syndrome
retrospective cohort study
作者简介
通讯作者:张青,zhangqingys@sina.com。
