结直肠癌根治术后辅助化疗白细胞降低的影响因素分析

Risk factors analysis for colorectal cancer adjuvant chemotherapy induced leucopenia

目的：观察结直肠癌根治术后辅助化疗白细胞降低的影响因素。方法收集接受结直肠癌根治术后辅助化疗的108例患者的临床资料并进行回顾性分析，按患者化疗后是否出现白细胞降低分为正常组（39例）和骨髓抑制组（69例）。使用SPSS 22.0软件建立数据库并进行统计分析，采用t检验、χ2检验、单变量分析及多因素Logistic回归分析和方差分析对结直肠癌术后辅助化疗白细胞降低的影响因素进行分析。结果单变量分析结果表明，女性、放疗是结直肠癌根治术后辅助化疗白细胞降低的危险因素（P＜0.01）；高血压、化疗前白细胞、中性粒细胞、血肌酐是结直肠癌根治术后辅助化疗白细胞降低的保护性因素（P＜0.05或＜0.01）。多因素Logistic回归分析结果表明，化疗前血肌酐及放疗是化疗后白细胞降低的独立危险因素，化疗前血肌酐的OR值为0.950（95%CI：0.906～0.996，P＜0.05），放疗的OR值为11.294（95%CI：2.993～42.613，P＜0.05）。进一步分析显示，患者化疗前血肌酐水平越低，化疗后白细胞降低程度越大（P＝0.04）。结论化疗前血肌酐水平是结直肠癌根治术后辅助化疗白细胞降低的独立危险因素。

Objective To investigate the risk factors for colorectal cancer adjuvant chemotherapy induced leucopenia. Methods The basic clinical data of 108 patients with colorectal cancer who had received radical operation and adjuvant chemotherapy were retrospectively evaluated. The patients were divided into two groups： normal white blood cell group （39 patients） and leucopenia group （69 patients）. The data were analyzed with SPSS 22.0 software, t test, χ2 test , univariate analysis and multifactor Logistic regression analysis, and analysis of variance to investigate the risk factors for colorectal cancer adjuvant chemotherapy induced leucopenia. Results Univariate analysis revealed that the female patients and the ones who received radiotherapy were more prone to leucopenia （P〈0.01）, while hypertension, the levels of white blood cell, neutrophil counting and serum creatinine before chemotherapy were protective factors for leucopenia （P〈0.05 or〈0.01）. Multifactor Logistic regression analysis revealed that the level of serum creatinine before chemotherapy was an independent risk factor for leucopenia, OR = 0.950 （95% CI： 0.906- 0.996, P〈0.05）. The further analysis showed the lower the level of serum creatinine, the more severe the leucopenia would be （P = 0.04）. Conclusions The level of serum creatinine before chemotherapy was an independent risk factor for colorectal cancer adjuvant chemotherapy induced leucopenia.