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

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。

Study on the development trajectory of early fatigue in patients with malignant melanoma treated with immune checkpoint inhibitors

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.