中国临床药学杂志

目的探讨卡培他滨联合奥沙利铂化疗方案(XELOX)致血小板减少症(CIT)的相关风险因素,建立CIT风险预测评分系统。方法通过电子病历系统收集使用XELOX的胃肠癌患者的相关病历资料,建立CIT风险预测评分系统的"训练集"数据库。采用多因素Logistic回归法进行CIT风险因素分析并建立CIT风险预测评分系统。最后以"验证集"对评分系统进行外部验证。结果使用多因素Logistic回归法得出年龄、体质量指数、肝转移、是否进行腹会阴联合直肠癌根治术、基础血小板计数和基础中性粒细胞计数可作为CIT的独立风险因素。利用比值比(OR)值对风险因素进行赋值,建立风险预测评分系统,确定评分>6.65分为高危人群,≤6.65分为低危人群。模型评价显示,"训练集"ROC曲线下面积为0.694,灵敏度、特异度分别为75.6%和53.2%;"验证集"ROC曲线下面积为0.683,灵敏度、特异度分别为76.0%和54.4%。结论 XELOX化疗患者致CIT的风险预测评分系统的建立,有助于筛选CIT高危患者,为临床预防性应用升血小板药物提供决策依据。

AIM To investigate the risk factors of chemotherapy-induced thrombocytopenia(CIT) by capecitabine combined with oxaliplatin(XELOX), and establish a risk prediction scoring system for CIT. METHODS The "training set" database of the CIT risk prediction scoring system was established by collecting relevant medical records of XELOX patients with gastrointestinal cancer through an electronic medical record system. Multi-factor Logistic regression method was used to analyze CIT risk factors and establish CIT risk prediction scoring system. Finally, the self-built scoring system was externally verified by "verification set". RESULTS Multivariate Logistic regression analysis of risk factors of CIT showed that age, body mass index, presence of liver metastasis, surgical method of abdominal-perineum combined with radical resection of rectal cancer, basic platelet count and basic absolute neutrophilic count were independent risk factors for CIT. The odds ratio(OR value) was used to assign the risk factors, and a risk prediction scoring system was established to determine that >6.65 was classified as high-risk group and ≤6.65 as low-risk group.The model evaluation showed that the area under the ROC curve of "training set" was 0.694, and the sensitivity and specificity were 75.6% and 53.2% respectively. The area under the ROC curve of "verification set" was 0.683, and the sensitivity and specificity were 76.0% and 54.4% respectively. CONCLUSION Establishment and verification of CIT risk prediction and scoring system for XELOX chemotherapy patients is helpful for screening high-risk CIT patients and providing decision-making basis for clinical prophylactic use of platelet-elevating drugs.