多柔比星脂质体对DLBCL化疗致手足综合征的危险因素分析及防治措施

Risk Factors of PEGylated Liposomal Doxorubicin Induced Hand-Foot Syndrome in Diffuse Large B Cell Lymphoma Patients and the Prophylactico-therapeutic Measures

目的:观察弥漫大B细胞淋巴瘤(DLBCL)接受含多柔比星脂质体(PLD)方案化疗患者手足综合征(HFS)的发生情况,分析其发生的危险因素。方法:收集2015年1月~2016年10月收治的使用含PLD方案化疗的DLBCL患者的资料,进行回顾性研究,采用多因素Logistic回归分析,探讨HFS的危险因素。结果:49例含PLD方案化疗的DLBCL患者中,HFS的发生率为30.6%(15/49),其中73.3%(11/15)HFS发生在化疗第2疗程后。在发生HFS患者和不发生HFS患者比较中,患者接受PLD化疗平均治疗疗程数和疗效差异无统计学意义,而剂量强度(40 mg·m2,P=0.049)、胆结石病史(P=0.007)、丙氨酸氨基转移酶(ALT,P=0.000)、门冬氨酸氨基转移酶(AST,P=0.000)、总胆红素(TBIL,P=0.044),差异有统计学意义(P<0.05)。对差异具有统计学意义的相关因素进行多因素Logistic回归分析,得出剂量强度、胆结石病史、ALT升高、AST升高为HFS发生的独立相关危险因素。结论:对具有这些危险因素的患者,有必要采取防治措施,预防HFS的发生,在保证治疗效果的同时提高患者治疗的依从性和生活质量。

Objective： To analyze the risk factors of PEGylated liposomal doxorubicin （PLD） induced hand-foot syndrome （HFS） in diffuse large B cell lymphoma （DLBCL） patients. Methods： The data of 49 DLBCL patients treated with chemotherapy regimens containing PLD from January 2015 to October 2016 were studied. Results： For those using PLD, 30.61 percent （15/49） of the patients developed HFS, and 73.3 percent （11/15） of the HFS cases occurred after 2 infusion cycles. The average course of treatment and efficacy do not significantly differ between the patients with and without HFS. However, Dose intensity （40 mg·m2）, history of gallstones, alanine aminotransferase （ALT）, aspartate aminotransferase （AST） and total bilirubin （TBIL） significantly differed between the HFS and non-HFS patients, which were analyzed by multivariate logistic regression analysis. It showed that the risk factors of HFS were dose intensity, history of gallstones, ALT and AST. Conclusion： For patients who have risk factors, it is necessary to take the prophylactic-therapeutic measures to prevent the occurrence of HFS, to ensure the treatment effect and to improve the compliance and quality of the patients＇ life.