奥沙利铂相关神经毒性及其影响因素分析

Analysis of the Influencing Factors of Neurological Toxicity Associated with Oxaliplatin

目的探讨奥沙利铂致神经毒性的发生率及其高危因素,为奥沙利铂相关神经毒性的预防提供参考。方法采用病例回顾性研究,对住院化疗期间使用奥沙利铂的患者进行数据采集,观察奥沙利铂致神经毒性的发生情况、发生程度与患者的一般状况、化疗前后临床检验指标的变化及与辅助用药的情况。采用统计学方法比较出现神经毒性组与未出现神经毒性组的组间差异,再对有显著性差异的观察指标进行Logistic回归分析,筛选神经毒性的相关危险因素。结果共纳入有效病例1 216例。发生奥沙利铂相关神经毒性817例(67.19%),其中临床诊断、疾病分期、体表面积、化疗次数、药物蓄积量、化疗前后白细胞变化、化疗前后淋巴细胞的变化、化疗前后血小板的变化、化疗前后钙的变化、使用钙镁补充剂等共12项指标有统计学差异(P<0.05)。化疗前后血小板的变化、疾病分期、药物蓄积量为神经毒性的影响因素。结论奥沙利铂相关的神经毒性发生率较高,应引起临床足够重视。特别是化疗前后血小板的变化大、疾病分期晚、药物蓄积大的患者,应密切监护神经毒性的临床表现,积极采取预防措施,必要时给予停药及对症处理。

OBJECTIVE To discuss the incidence and influencing factors of oxaliplatin related neurological toxicity and provide reference for prevent of the oxaliplatin related neurological toxicity. METHODS It was a retrospective study of inpatients treated with chemotherapy by oxaliplatin. To collect the data of incidence rate of the oxaliplatin related neurological toxicity, general condition of the inpatients, monitored value of blood-biochemistry and the circumstance of adjuvant medicines. Compared the intergroup difference between the 2 groups of patients who occurred the oxaliplatin related neurological toxicity or no by statistics analysis, and observed the index by Logistic regression analysis to investigate the risk of factors in oxaliplatin related neurological toxicity. RESULTS It contained a total of 1 216 valid cases. Oxaliplatin related neurological toxicity occurred in 817 cases（67.19%）. Compared the 2 groups of patients who occurred Oxaliplatin related neurological toxicity or no,the results showed that the clinical diagnoses, staging of disease, body surface area, number of chemotherapy, retained drug dose, and the numerical value of the white blood cell count, lymphocytic count, thrombocyte count, calcium ion which were changed before and after chemotherapy, and whether complicated with Calcium/magnesium（Ca/Mg） mixtures. Twelve indicators had a statistically significant difference between the 2 group（P〈0.05）. Observed indexes of the P〈0.05 by logistic regression analysis, the results showed that the numerical value variation of thrombocyte count, staging of disease, retained drug dose were the influence factors of oxaliplatin related neurological toxicity thrombocyte count before and after chemotherapy. CONCLUSION It is a high level of the incidence of oxaliplatin related neurological toxicity, which should be payed enough attention.Especially the patiens who change of the numerical value of thrombocyte count has been momentous, later of the staging of disease, high level of the retained drug dose should be frequently monitored the clinical manifestation of the oxaliplatin related neurological toxicity, and take withdrawal or symptomatic treatment when necessary.