共患病评分在急性髓系白血病患者化疗并发症中的判断研究  

Role of comorbidity score in predicting the risk of chemotherapy toxicity in patients with acute myeloid leukemia

作　　者：郭文坚[1] 黄河[1] 何牧卿[1] 姚荣欣[1] 董爱淑[1] 

机构地区：[1]温州医科大学附属第二医院内科,浙江温州325027

出　　处：《中华全科医学》2016年第9期1501-1503,1591,共4页Chinese Journal of General Practice

基　　金：浙江省温州市2010年第二期科技项目(Y20100260)

摘　　要：目的 笔者认为共患病因素对急性髓系白血病患者化疗并发症有一定影响,本文通过共患病积分系统评估急性髓系白血病患者的共患病因素,以判断其与化疗严重并发症的关系,同时比较哪种积分系统更适合用于判断患者出现严重并发症的风险。方法 选择温州医科大学附属第二医院2010~2014年期间66例年龄≥40岁的初发急性髓系白血病患者,使用查尔森共患病积分（CCI）或是造血干细胞移植共患病积分（HCT-CI）评估患者的共患病因素,采用χ2检验或Fisher’s精确检验以及Spearman方法来判断关联性,同时在多因素分析中使用Logistic回归模型来判断相对危险度。结果 共患病高积分组[（CCI≥4,29例）或（HCT-CI≥3,22例）]中的患者出现化疗后严重感染的风险高于共患病低积分组[（CCI〈4,10例）或（HCT-CI〈3,17例）]中的患者,差异有统计学意义（P〈0.05）。但是高共患病积分与其他并发症无明显关联。多因素分析提示,高CCI积分（≥4）仍是化疗后出现严重感染的高危因素（OR=4.385,95%CI：1.134~16.924,P〈0.05）,高HCT-CI积分（≥3）却与化疗后出现严重感染不具有相关性,而在HCT-CI组中年龄≥60岁是化疗后出现严重感染的高危因素（OR=4.597,95%CI：1.002~21.146,P〈0.05）。结论 高CCI或HCT-CI积分急性髓系白血病患者可能容易在化疗后出现严重的感染,多因素分析提示,CCI积分系统更适合用于评估急性髓系白血病患者的共患病因素。Objective To evaluate the comorbidity factors by Charlson Comorbidity Index and hematopoietic cell trans- plantation comorbidity index, assess their relationships with chemotherapy toxicity, and discuss the suitability of the two in- dex. Methods Total 66 cases of first acute myeloid leukemia aged 40 or above in our hospital between 2010 and 2014 were enrolled into this study. Charlson Comorbidity Index and hematopoietic cell transplantation comorbidity index were used to evaluate the comorbidity factors. Chi-square test or Fisher＇ s exact test and Spearman＇ s rank correlation analysis were performed to analyze the correlations. Logistic regression model was employed to predict the relative risk. Results The incidence of severe infection in patients with high comorbidity score（ CCI≥4 ,29 cases or HCT-CI≥3,22 cases） was higher than that in patients with lower comorbidity score（ CCI 〈 4,10cases or HCT-CI 〈 3,17 cases）, the difference was statistical significant（P 〈 0.05）. But the high comorbidity score was not obviously correlated with the occurrence of other severe conditions. Multivariate analysis showed that high CCI score was still associated with an increased risk of severe in- fection in the CCI group（ OR = 4. 385,95% CI： 1. 134 - 16. 924 ; P 〈 0.05 ）, however, in the HCT-CI group, high HCT-CI score （≥3 ） was not obviously related to the severe infection after chemotherapy, but age （≥ 60 years） was associated with an increased risk of severe infection （ OR = 4. 597,95% CI： 1. 002 - 21. 146 ; P 〈 0.05 ）. Conclusion The patients with AML with high CCI or HCT-CI are easily to catch a severe infection after chemotherapy; Charlson Comorbidity Index is more suited for the prediction of comorbidity factors in patients with AML.

关 键 词：共患病 Charlson共患病积分 造血干细胞移植共患病积分 化疗并发症 急性髓系白血病 

分 类 号：R733.71[医药卫生—肿瘤] R730.53[医药卫生—临床医学]