低危妊娠滋养细胞肿瘤单药化疗耐药相关因素的分析与预测  

Analysis and Prediction of Factors Related to Single-agent Chemotherapy Resistance in Low-risk Gestational Trophoblastic Tumors

作　　者：镇澜[1] 郑祥钦[1] 宋建榕[1] 苏彦钊[1] 陈玲思[1] 陈宏[2] ZHEN Lan;ZHENG Xiang-qin;SONG Jian-rong;SU Yan-zhao;CHEN Ling-si;CHEN Hong(Department of Obstetrics and Gynecology,Fujian Provincial Maternity and Child Health Hospital/Affiliated Hospital of Fujian Medical University,Fuzhou,Fujian Province,350001 China;Department of Neurology,Fujian Medical University Provincial School of Clinical Medicine(Fujian Provincial Hospital),Fuzhou,Fujian Province,350001 China)

机构地区：[1]福建省妇幼保健院/福建医科大学附属医院妇产科,福建福州350001 [2]福建医科大学省立临床医学院/福建省立医院神经内科,福建福州350001

出　　处：《中外医疗》2020年第29期1-4,共4页China & Foreign Medical Treatment

摘　　要：目的研究低危妊滋养细胞肿瘤(gestational trophoblastic neoplasia,GTN)单药化疗耐药的相关因素,建立风险预测模型,为临床实践提供参考。方法回顾分析2010年1月—2019年11月收治于福建省妇幼保健院妇科的98例初治低危GTN患者的临床资料。结果经过计数资料的单因素分析,结果显示,化疗前血β-HCG值>5000 U/L组、肺部转移病灶数目≥5个组、FIGO/WHO评分为5~6分组、发病距前次妊娠时间≥7个月组耐药率高,更生霉素组耐药率低,均差异有统计学意义(P<0.05);经过Logistic回归分析,纳入预报模型的因素为化疗前血β-HCG值、化疗药物、年龄、发病距前次妊娠时间,该模型对训练样本的一致正确率为84.7%,该模型ROC曲线下面积为0.876,表明该预报模型预报能力良。结论对于低危GTN单药化疗患者,化疗前血β-HCG值、化疗药物、年龄、发病距前次妊娠时间情况是用于构建预测其耐药风险模型的相对最优因素,由此构建的模型具有良好的拟合优度和实用性,可为临床实践提供参考。Objective To study the related factors of low-risk gestational trophoblastic neoplasia(GTN)single-agent chemotherapy resistance,establish a risk prediction model,and provide reference for clinical practice.Methods A retrospective analysis of the clinical data of 98 newly-treated low-risk GTN patients admitted to the Department of Gynecology of Fujian Maternity and Child Health Hospital from January 2010 to November 2019.Results After univariate analysis of enumeration data,the results showed that the pre-chemotherapy bloodβ-HCG value>5000 U/L group,the number of lung metastatic lesions≥5 group,FIGO/WHO score 5-6 group,disease drug resistance rate was high in the group≥7 months from the previous pregnancy,and the drug resistance rate in the dactinomycin group was low,and the difference was statistically significant(P<0.05);after Logistic regression analysis,the factor included in the prediction model was blood before chemotherapyβ-HCG value,chemotherapeutics,age,and time from previous pregnancy onset.The consistent accuracy rate of this model for training samples was 84.7%,and the area under the ROC curve of this model was 0.876,indicating that this forecasting model had good forecasting ability.Conclusion For low-risk GTN single-agent chemotherapy patients,the bloodβ-HCG value before chemotherapy,chemotherapy drugs,age,and time from onset to the previous pregnancy are the relatively optimal factors for constructing a model for predicting the risk of drug resistance.The model has good goodness of fit and practicality,which can provide reference for clinical practice.

关 键 词：妊娠滋养细胞肿瘤 单药化疗 耐药 高危因素 保护因素 

分 类 号：R5[医药卫生—内科学]