恶性黑色素瘤术后患者免疫检查点抑制剂辅助治疗早期疲劳发展轨迹研究

doi:10.3761/j.issn.0254-1769.2022.20.008

摘要/Abstract

摘要：

目的免疫检查点抑制剂中的程序性细胞死亡蛋白受体1（programmed cell death protein1,PD-1）抑制剂已被用于多种晚期肿瘤的治疗中,该研究旨在识别恶性黑色素瘤术后PD-1抑制剂单药辅助治疗患者早期疲劳发展轨迹及其影响因素。方法采用便利抽样法,选取2020年4月—2021年12月于河南省某三级肿瘤医院和吉林省某三级甲等医院肿瘤科住院的患者作为调查对象,采用癌症疲乏量表调查患者首次PD-1抑制剂治疗后1、2、3、4周后的疲乏现状,利用组基轨迹模型识别106例PD-1抑制剂单药辅助治疗患者早期疲劳症状发展轨迹,运用多元Logistic回归分析患者早期疲劳症状发展轨迹的影响因素。结果识别出“疲劳缓解组”和“疲劳升高组” 2种早期疲劳发展轨迹。单因素分析结果显示,各亚组在肿瘤部位、自理能力、休息后是否缓解、伴有其他免疫相关不良事件个数方面的差异均具有统计学意义（P<0.05）。多元Logistic回归分析结果显示,早期疲劳症状休息后缓解[RR=0.026,95%CI（0.004,0.179）]、不伴有其他免疫相关不良事件[RR=0.255,95%CI（0.181,0.361）]被归属为类型2“疲劳升高组”的可能性较小。结论恶性黑色素瘤术后患者PD-1抑制剂辅助治疗早期疲劳发展呈现不同的变化轨迹,护士应重视疲劳症状休息后不缓解、伴有其他免疫相关不良事件患者早期疲劳症状的评估和干预。

关键词: 恶性黑色素瘤, 免疫检查点抑制剂, 程序性死亡受体1抑制剂, 疲劳, 组基轨迹模型, 护理

Abstract:

Objective To identify the development trajectory of early fatigue and its influencing factors in patients with malignant melanoma treated with PD-1 inhibitor. Methods Using the longitudinal data of patients with malignant melanoma after operation,the Group - Based Trajectory Model was used to identify the development trajectory of early fatigue symptoms in 106 patients with PD-1 inhibitors single drug adjuvant treatment,and the multiple logistic regression was used to analyze the influencing factors of the development trajectory of early fatigue symptoms. Results 2 early fatigue development trajectories of “fatigue relieving group” and “fatigue increasing group” were identified. Univariate analysis showed that there were significant differences in tumor location（ χ²=9.046,P=0.011）,self-care ability（ χ²=20.407,P<0.001）,remission after rest（ χ²=54.804,P<0.001） and the number of other irAEs（ χ²=26.312,P<0.001） among the subgroups. Multiple logistic regression analysis showed that early fatigue symptoms relieved after rest （RR=0.026,95%CI[0.004,0.179]） and accompanied by 0 other irAEs（RR=0.255,95%CI[0.181,0.361]） were less likely to be classified as type 2 “increased fatigue group”. Conclusion The development of early fatigue in patients with malignant melanoma treated with PD-1 inhibitor as a single drug adjuvant showed different changing trajectories. Nurses should pay attention to the evaluation and intervention of early fatigue symptoms in patients with non relief of fatigue symptoms after rest and other irAEs.

Key words: Malignant Melanoma, Immune Checkpoint Inhibitors, Programmed Cell Death Protein 1 Inhibitor, Fatigue, Group Based Trajectory Model, Nursing Care

李蕾蕾, 杨长永, 胡玉冰, 屈辉, 付朝红, 彭月香, 马筱慧. 恶性黑色素瘤术后患者免疫检查点抑制剂辅助治疗早期疲劳发展轨迹研究[J]. 中华护理杂志, 2022, 57(20): 2487-2492.

LI Leilei, YANG Changyong, HU Yubing, QU Hui, FU Chaohong, PENG Yuexiang, MA Xiaohui. Study on the development trajectory of early fatigue in patients with malignant melanoma treated with immune checkpoint inhibitors[J]. Chinese Journal of Nursing, 2022, 57(20): 2487-2492.

图/表 5

表1 患者4个时间点疲劳得分及相关性（n=106,r值）

Table 1 Score and correlation of patients’ fatigue at 4 time points（n=106,r value）

表2 患者早期疲劳应用组基轨迹模型拟合情况

Table 2 GBTM fitting for patients with early fatigue

图1 早期疲劳轨迹图

Figure 1 Trajectory of early fatigue

表3 患者疲劳轨迹的单因素分析[例（百分比,%）]

Table 3 Single factor analysis of patient fatigue trajectory [case（percentage,%）]

表4 疲劳轨迹的Logistic回归分析结果

Table 4 Logistic regression analysis of fatigue trajectory

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