贝伐珠单抗致蛋白尿临床分析

Clinical analysis of bevacizumab-induced proteinuria

目的探讨接受贝伐珠单抗治疗的肿瘤患者蛋白尿发生的危险因素。方法回顾性分析2017年6月至2020年6月于苏州大学附属第一医院接受贝伐珠单抗治疗的晚期肿瘤205例(结直肠癌130例,非小细胞肺癌69例,宫颈癌2例,卵巢癌2例,乳腺癌2例)患者的临床资料,依据用药后尿蛋白情况,分为蛋白尿组(30例)和非蛋白尿组(175例),分析两组差异,纳入Logistic回归模型,绘制ROC曲线确定蛋白尿发生的最佳临界值。结果 Logistic回归显示,累积剂量(OR=1.224,95%CI:1.082~1.383,P=0.001)及收缩压(OR=1.039,95%CI:1.009~1.069,P=0.011)是导致蛋白尿发生的独立影响因素;ROC曲线分析发现,蛋白尿发生的累积剂量最佳临界值是3.1 g,收缩压是154 mm Hg。蛋白尿组有12例患者停药,8例停药患者蛋白尿转阴或减轻。结论贝伐珠单抗累积剂量高及收缩压高是贝伐珠单抗致蛋白尿的危险因素,临床可对累积剂量≥3.1 g和收缩压≥154 mm Hg的情况加以重视,早期停药以减少蛋白尿的发生。

Objective To investigate the risk factors of proteinuria in tumor patients treated with bevacizumab.Methods A retrospective analysis was performed on the clinical data of 205 patients with advanced tumor receiving bevacizumab treatment at the First Affiliated Hospital of Suchow University from June 2017 to June 2020(including 130 colorectal cancer patients,69 non-small cell lung cancer patients,2 cervical cancer patients,2 ovarian cancer patients and 2 breast cancer patients).According to the urinary protein level after medication,the patients were divided into proteinuria group(n=30)and non-proteinuria group(n=175).Logistic regression model was used to analyze the risk factors of proteinuria in two groups,and receiver operating characteristic(ROC)curve was drawn to determine the best critical value for proteinuria.Results The logistic regression model showed that large cumulative dose of bevacizumab(OR=1.224,95%CI:1.082-1.383,P=0.001)and high systolic blood pressure(OR=1.039,95%CI:1.009-1.069,P=0.011)were the independent factors for proteinuria.ROC curve analysis found that the best critical value of cumulative dose of bevacizumab for diagnosing proteinuria was 3.1 g,and the systolic blood pressure was 154 mm Hg.In proteinuria group,12 patients stopped taking the drug,and 8 patients presented with negative or low proteinuria.Conclusions Large cumulative dose and high systolic blood pressure are the risk factors for proteinuria in the patients receiving bevacizumab chemotherapy.Early with drawal of bevacizumab can reduce the incidence of proteinuria.