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目的笔者认为共患病因素对急性髓系白血病患者化疗并发症有一定影响,本文通过共患病积分系统评估急性髓系白血病患者的共患病因素,以判断其与化疗严重并发症的关系,同时比较哪种积分系统更适合用于判断患者出现严重并发症的风险。方法选择温州医科大学附属第二医院2010~2014年期间66例年龄≥40岁的初发急性髓系白血病患者,使用查尔森共患病积分(CCI)或是造血干细胞移植共患病积分(HCT-CI)评估患者的共患病因素,采用χ~2检验或Fisher’s精确检验以及Spearman方法来判断关联性,同时在多因素分析中使用Logistic回归模型来判断相对危险度。结果共患病高积分组[(CCI≥4,29例)或(HCT-CI≥3,22例)]中的患者出现化疗后严重感染的风险高于共患病低积分组[(CCI<4,10例)或(HCT-CI<3,17例)]中的患者,差异有统计学意义(P<0.05)。但是高共患病积分与其他并发症无明显关联。多因素分析提示,高CCI积分(≥4)仍是化疗后出现严重感染的高危因素(OR=4.385,95%CI:1.134~16.924,P<0.05),高HCT-CI积分(≥3)却与化疗后出现严重感染不具有相关性,而在HCT-CI组中年龄≥60岁是化疗后出现严重感染的高危因素(OR=4.597,95%CI:1.002~21.146,P<0.05)。结论高CCI或HCT-CI积分急性髓系白血病患者可能容易在化疗后出现严重的感染,多因素分析提示,CCI积分系统更适合用于评估急性髓系白血病患者的共患病因素。
Objective I believe that co-morbidity factors in patients with acute myeloid leukemia have some impact on chemotherapy complications in this article through the comorbidity score system to assess co-morbidity factors in patients with acute myeloid leukemia in order to determine the serious complications of chemotherapy and its relationship, At the same time what kind of integral system is more suitable for judging the patient’s risk of serious complications. Methods A total of 66 primary acute myeloid leukemia patients aged 40 years or older from 2010 to 2014 in the Second Affiliated Hospital of Wenzhou Medical University were enrolled in the study. HCT-CI) were used to assess the co-morbidity of patients. Chi-square test or Fisher’s exact test and Spearman’s method were used to evaluate the association. Logistic regression was used to determine the relative risk in multivariate analysis. Results Patients in the co-morbid high-risk group [(CCI ≥4,29) or (HCT-CI ≥3,22)] had a higher risk of severe infection after chemotherapy than those with low-co-morbidity [(CCI < 4,10 cases) or (HCT-CI <3,17 cases)] patients, the difference was statistically significant (P <0.05). However, there was no significant correlation between the comorbid points and other complications. Multivariate analysis showed that high CCI (≥4) was still a high risk factor for serious infection after chemotherapy (OR = 4.385,95% CI: 1.134-16.924, P <0.05), high HCT-CI score It was not associated with severe infection after chemotherapy. However, in HCT-CI group, patients ≥60 years of age were at high risk of serious infection after chemotherapy (OR = 4.597,95% CI: 1.002-21.146, P <0.05). Conclusions Patients with acute myeloid leukemia with high CCI or HCT-CI score may be prone to severe infection after chemotherapy. Multivariate analysis suggests that the CCI score system is more suitable for the evaluation of co-morbidity factors in patients with acute myeloid leukemia.