目的 探討在5-羥色胺3（5-HT₃）受體拮抗劑聯(lián)合地塞米松的基礎上加用氟哌噻噸美利曲辛對于預防化療相關惡心嘔吐（CINV）的臨床效果，為臨床用藥提供參考。方法 采用回顧性隊列研究，以鄭州市第三人民醫(yī)院2017年1月-2021年10月收治的955例化療患者為對象，收集患者臨床資料。以是否使用氟哌噻噸美利曲辛分為用藥組和對照組，采用1：1傾向評分匹配法（PSM）平衡組間基線差異。比較組間CINV發(fā)生情況，并用修正Poisson回歸進行多因素矯正。根據(jù)患者基線進行分層分析，采用breslow-day檢驗層間一致性，對于層間不一致的因素進行亞組分析。采用多因素Logistic回歸進行敏感性分析。結果 匹配后用藥組與對照組各155例，CINV發(fā)生率（26.45%vs 34.19%，P=0.138），多因素結果RR=0.84，95% CI （0.62~1.13），P=0.255，把握度31.59%。分層分析結果顯示，胃腸道疾病史[OR=0.95，95% CI（0.53~1.73）vs OR=0.30，95% CI（0.12~0.78）]，層間差異具有統(tǒng)計學意義（P=0.042）。有胃腸道疾病史患者重新匹配，匹配后用藥組與對照組各42例，CINV發(fā)生率（35.71%vs 64.29%，P=0.009），多因素分析結果RR=0.60，95% CI（0.42~0.87），P=0.007。敏感性分析結果與主分析結果一致。結論 對于有胃腸道疾病史的患者，在5-HT3受體拮抗劑聯(lián)合地塞米松的基礎上加用氟哌噻噸美利曲辛可降低CINV的發(fā)生率。

Objective To explore the clinical effect of Flupentixol-Melitracen on the basis of 5-HT₃ receptor antagonist combined with dexamethasone in preventing chemotherapy-related nausea and vomiting (CINV), and to provide a reference for clinical medication. Methods A retrospective cohort study was conducted based on the clinical data collected from 955 chemotherapy cases in The Third People's Hospital of Zhengzhou from January 2017 to October 2021. The cases were divided into two groups, the medication group and the control group, based on whether Flupentixol-Melitracen was used. The 1:1 propensity score matching method (PSM) was used to balance the baseline differences between the two groups. The occurrences of CINV of both groups were compared, and the modified Poisson regression was used for multivariate correction. Stratified analysis was performed based on the patient's baseline. The brslow-day test was used to test the consistency between the layers, and a subgroup analysis was carried out to account for the factors of inconsistency between the layers. The multivariate logistic regression was used for sensitivity analysis. Results The following results were obtained after analyzing 155 cases each from the medication group and the control group:The incidence of CINV (26.45% vs 34.19%, P=0.138), multivariate results RR=0.84, 95%CI (0.62-1.13), P=0.255, and power (31.59%). The results of the stratified analysis showed that the difference between layers was statistically significant (P=0.042) based on the history of patients' gastrointestinal diseases[OR=0.95, 95% CI (0.53-1.73) vs OR=0.30, 95%CI (0.12-0.78)]. Therefore, patients with a history of gastrointestinal diseases were re-grouped. After re-grouping, there were 42 cases each from the medication group and the control group. The following results were also obtained with the same analysis:The incidence of CINV (35.71% vs 64.29%, P=0.009), multivariate results RR=0.60, 95%CI (0.42-0.87), P=0.007. The sensitivity analysis result is consistent with the main analysis result. Conclusion For patients with a history of gastrointestinal diseases, the addition of Fluphenazine-Melitracen to 5-HT3 receptor antagonist combined with dexamethasone can reduce the incidence of CINV.

R979.1

河南省重點研發(fā)與推廣專項（202102310456）；河南省醫(yī)學科技攻關項目（LHGJ20200721）