目的 探讨在5-羟色胺3（5-HT₃）受体拮抗剂联合地塞米松的基础上加用氟哌噻吨美利曲辛对于预防化疗相关恶心呕吐（CINV）的临床效果，为临床用药提供参考。方法 采用回顾性队列研究，以郑州市第三人民医院2017年1月-2021年10月收治的955例化疗患者为对象，收集患者临床资料。以是否使用氟哌噻吨美利曲辛分为用药组和对照组，采用1：1倾向评分匹配法（PSM）平衡组间基线差异。比较组间CINV发生情况，并用修正Poisson回归进行多因素矫正。根据患者基线进行分层分析，采用breslow-day检验层间一致性，对于层间不一致的因素进行亚组分析。采用多因素Logistic回归进行敏感性分析。结果 匹配后用药组与对照组各155例，CINV发生率（26.45%vs 34.19%，P=0.138），多因素结果RR=0.84，95% CI （0.62~1.13），P=0.255，把握度31.59%。分层分析结果显示，胃肠道疾病史[OR=0.95，95% CI（0.53~1.73）vs OR=0.30，95% CI（0.12~0.78）]，层间差异具有统计学意义（P=0.042）。有胃肠道疾病史患者重新匹配，匹配后用药组与对照组各42例，CINV发生率（35.71%vs 64.29%，P=0.009），多因素分析结果RR=0.60，95% CI（0.42~0.87），P=0.007。敏感性分析结果与主分析结果一致。结论 对于有胃肠道疾病史的患者，在5-HT3受体拮抗剂联合地塞米松的基础上加用氟哌噻吨美利曲辛可降低CINV的发生率。

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

河南省重点研发与推广专项（202102310456）；河南省医学科技攻关项目（LHGJ20200721）