进展期结直肠癌患者化疗相关性腹泻发生状况及影响因素研究

doi:10.3761/j.issn.1672-9234.2022.05.015

摘要/Abstract

摘要：

目的探讨进展期结直肠癌患者化疗相关性腹泻（chemotherapy-induced diarrhea,CID）的发生状况及影响因素。方法选取2020年1月—2021年6月福建某三级甲等肿瘤专科医院进行联合化疗的进展期结直肠癌患者为研究对象,采用自制的调查表对患者的一般资料及腹泻情况进行回顾分析。结果 224例结直肠癌患者共计完成1 176例次化疗,共有622例次发生CID,发生率为52.9%。进展期结直肠癌患者化疗期间CID发生率随着化疗周期的推进呈线性下降趋势（χ²=4.411,P=0.036）。Logistic回归分析结果显示,年龄≥65岁（OR=1.643,P<0.001）、ECOG评分≥2分（OR=1.379,P=0.009）、胆红素计数≥13 mg/L（OR=2.435,P<0.001）是进展期结直肠癌患者化疗相关性腹泻发生的影响因素。结论进展期结直肠癌患者联合化疗期间易发生化疗相关性腹泻,且随着化疗疗程的推进,CID的发生率总体呈下降趋势;临床当中应重点关注年龄≥65岁、ECOG≥2分、胆红素计数≥13 mg/L的患者,并采取相应的预防措施,以减少CID的发生。

关键词: 结直肠肿瘤, 放化疗,辅助, 腹泻, 回顾性研究, 影响因素分析

Abstract:

Objective To investigate the current status and influencing factors of chemotherapy-induced diarrhea （CID） in patients with advanced colorectal cancer. Methods Advanced colorectal cancer patients who underwent combined chemotherapy in a tertiary cancer hospital in Fujian from January 2020 to June 2021 were recruited. The general information and diarrhea of patients were retrospectively analyzed by self-made questionnaire. Results A total of 1 176 chemotherapy sessions were completed in 224 patients with colorectal cancer,and 622 chemotherapy-induced diarrhea occurred. The case-time incidence of CID was 52.9%. The incidence of CID in advanced colorectal cancer patients during chemotherapy showed a linear downward trend with the progress of the chemotherapy cycle（χ²=4.411,P=0.036）. Logistic regression analysis showed that age≥65 years old（OR=1.643,P<0.001）,ECOG score≥2 points（OR=1.379,P=0.009）and the bilirubin count≥13 mg/L（OR=2.435,P<0.001）were the influencing factors of chemotherapy-induced diarrhea in patients with advanced colorectal cancer. Conclusion Advanced colorectal cancer patients are prone to chemotherapy-induced diarrhea during chemotherapy,and the case-time incidence of CID decreases with the advancement of chemotherapy course. In clinical practice,we should focus on patients with age≥65 years old,ECOG≥2 points and the bilirubin count≥13 mg/L,and take corresponding preventive measures to reduce the occurrence of CID.

Key words: Colorectal Neoplasms, Chemoradiotherapy,Adjuvant, Diarrhea, Retrospective Studies, Root Cause Analysis

张云飞,骆惠玉,朱虹玉,黎茂璐,徐珍华,柯熹. 进展期结直肠癌患者化疗相关性腹泻发生状况及影响因素研究[J]. 中华护理教育, 2022, 19(5): 462-466.

ZHANG Yun-fei,LUO Hui-yu,ZHU Hong-yu,LI Mao-lu,XU Zhen-hua,KE Xi. The current status and influencing factors of chemotherapy-related diarrhea in patients with advanced colorectal cancer[J]. Chinese Journal of Nursing Education, 2022, 19(5): 462-466.

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参考文献 20

[1]	Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018:GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2018, 68(6):394-424. doi: 10.3322/caac.21492
[2]	徐敏, 朱美琴, 白桦, 等. 伊立替康联合替吉奥改良化疗方案治疗转移性结直肠癌的效果[J]. 广东医学, 2015, 36(9):1421-1423.
[3]	韩惠萍, 张丽娇, 董洁晨, 等. 复方谷氨酰胺肠溶胶囊联合葛根芩连汤防治晚期结直肠癌FOLFIRI方案化疗相关性腹泻疗效及对肠黏膜通透性和免疫细胞因子的影响[J]. 现代中西医结合杂志, 2017, 26(33):3667-3670,3739.
[4]	李慧文, 谢茗珠, 张晓菊, 等. 直肠癌患者化疗相关性腹泻的循证实践研究[J]. 上海护理, 2019, 19(3):12-16.
[5]	国家卫生和计划生育委员会医政医管局, 中华医学会肿瘤学分会. 中国结直肠癌诊疗规范(2017年版)[J]. 中国实用外科杂志, 2018, 38(10):1089-1103. doi: 10.19538/j.cjps.issn1005-2208.2018.10.01
[6]	皈燕, 谢力, 舒晓红, 等. 川东北地区人群UGT1A1*28基因多态性与晚期结直肠癌患者伊立替康化疗所致毒性反应的相关性研究[J]. 中国急救医学, 2015, 35(S2):373-375.
[7]	Mego M, Chovanec J, Vochyanova-Andrezalova I, et al. Prevention of irinotecan induced diarrhea by probiotics:a randomized double blind,placebo controlled pilot study[J]. Complement Ther Med, 2015, 23(3):356-362. doi: 10.1016/j.ctim.2015.03.008
[8]	Freites-Martinez A, Santana N, Arias-Santiago S, et al. Using the common terminology criteria for adverse events(CTCAE-version 5.0) to evaluate the severity of adverse events of anticancer therapies[J]. Actas Dermosifiliogr(Engl Ed), 2021, 112(1):90-92.
[9]	Kon R, Tsubota Y, Minami M, et al. CPT-11-induced delayed diarrhea develops via reduced aquaporin-3 expression in the colon[J]. Int J Mol Sci, 2018, 19(1):170. doi: 10.3390/ijms19010170
[10]	Swami U, Goel S, Mani S. Therapeutic targeting of CPT-11 induced diarrhea:a case for prophylaxis[J]. Curr Drug Targets, 2013, 14(7):777-797. doi: 10.2174/1389450111314070007
[11]	徐素珍. 结直肠癌患者化疗相关性腹泻的临床研究[D]. 杭州:浙江大学, 2014.
[12]	Fujii H, Yamada Y, Watanabe D, et al. Dose adjustment of irinotecan based on UGT1A1 polymorphisms in patients with colorectal cancer[J]. Cancer Chemother Pharmacol, 2019, 83(1):123-129. doi: 10.1007/s00280-018-3711-8
[13]	Sun RJ, Zhu LJ, Li L, et al. Irinotecan-mediated diarrhea is mainly correlated with intestinal exposure to SN-38:critical role of gut Ugt[J]. Toxicol Appl Pharmacol, 2020, 398:115032. doi: 10.1016/j.taap.2020.115032
[14]	Andreyev J, Ross P, Donnellan C, et al. Guidance on the management of diarrhoea during cancer chemotherapy[J]. Lancet Oncol, 2014, 15(10):e447-e460.
[15]	梅丹, 陆俊国, 顾海娟, 等. 伊立替康化疗相关性腹泻发生的特点与危险因素分析[J]. 中国医院药学杂志, 2019, 39(2):191-195.
[16]	Paulík A, Grim J, Filip S. Predictors of irinotecan toxicity and efficacy in treatment of metastatic colorectal cancer[J]. Acta Medica(Hradec Kralove), 2012, 55(4):153-159.
[17]	Cremolini C, Antoniotti C, Rossini D, et al. Upfront FOLFOXIRI plus bevacizumab and reintroduction after progression versus mFOLFOX6 plus bevacizumab followed by FOLFIRI plus bevacizumab in the treatment of patients with metastatic colorectal cancer(TRIBE2):a multicentre,open-label,phase 3,randomised,controlled trial[J]. Lancet Oncol, 2020, 21(4):497-507. doi: S1470-2045(19)30862-9 pmid: 32164906
[18]	Dranitsaris G, Shah A, Spirovski B, et al. Severe diarrhea in patients with advanced-stage colorectal cancer receiving FOLFOX or FOLFIRI chemotherapy:the development of a risk prediction tool[J]. Clin Colorectal Cancer, 2007, 6(5):367-373. doi: 10.3816/CCC.2007.n.006
[19]	Kweekel D, Guchelaar HJ, Gelderblom H. Clinical and pharmacogenetic factors associated with irinotecan toxicity[J]. Cancer Treat Rev, 2008, 34(7):656-669. doi: 10.1016/j.ctrv.2008.05.002
[20]	Meyerhardt JA, Kwok A, Ratain MJ, et al. Relationship of base-line serum bilirubin to efficacy and toxicity of single-agent irinotecan in patients with metastatic colorectal cancer[J]. J Clin Oncol, 2004, 22(8):1439-1446. pmid: 15084617