難治性化療所致惡心嘔吐的列線圖預(yù)測(cè)模型建立與評(píng)估

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中圖分類號(hào)R730.6；R975+.4 文獻(xiàn)標(biāo)志碼A 文章編號(hào)1001-0408（2025）09-1105-06

DOI 10.6039/j.issn.1001-0408.2025.09.15

ABSTRACTOBJECTIVETo construct and evaluate nomogram prediction model forrefractory chemotherapy-induced nausea andvomiting（CINV）.METHODSThedata of malignanttumorpatientswhoreceived chemotherapyatthe ThirdPeople's HospitalofZhengzhoufromJanuary2O17toDecember2023werecolected.Thesepatientswerecategorizedintotheocurrence groupandthenon-occurrene groupaccording totheoccurrenceofrefractry CINV.Multivariate Logisticregressonanalysis was employedtoscreen predictivefactors forrefractory CINVandconstructinganomogram predictionmodel.Modelperformancewas assessed viareceiver operating charactersticcurveanalysis.Modelcalibration was evaluatedusing Bootstrapresampling.Decision curveanalysis（DCA）wasusedtodeterminetheclinicalnetbenefitof thre strategiesunderdiferentriskthresholds.Clinical impactcurveswereutilizedtoassesstheclinicalvalueofthemodelatdiferentriskthresholds.Shapleyadditiveexplanations （SHAP）analysiswasperformedtoevaluateindividual factorcontributionstothepredictivemodel.RESULTSAtotalof 388 patientswereincluded，with19experiencingrefractoryCVMultivarateLogisticgressonidentifed1predictiefctorsfor refractoryCINV，includinggastrointestinaldiseasehistory，anticipatednauseaandvomiting，chemotherapy-iducedemeticrisk classification，and electrolyte levels，etc.The model's area under the curve was 0.80 [ 9 5 % confidence interval （0.76，0.84）]，with ameanerrorofO.036.DCAdemonstratedthepredictionmodelhadhigherclinicalnetbenefitwhentheriskthresholdwasbetween 0.05andO.85.SHAPanalysisrevealedthetopthreepredictivefactorsasgastrointestinal diseasehistory（O.924），chemotherapyinducedemeticriskclassfication（0.866），andelectrolytelevels（0.581）.CONCLUSIONSElevenfactors，including gastrointestinalseasestoryanticipatednuseaandoitingemoterapyiucedeticskclasificationandelectolte levels，areidentifiedaspredictorsofrefractoryCINV.Themodelbasedonthesefactors hasgoodpredictiveability，whichcanbe used to predict the risk of refractory CINV.

KEYWORDS chemotherapy-induced nausea and vomiting；refractory；prediction model； nomogram

化療所致惡心嘔吐（chemotherapy-inducednauseaandvomiting，CINV）是化療過(guò)程中常見(jiàn)的不良反應(yīng)之一，不僅會(huì)影響患者的生存質(zhì)量和治療依從性，還可能導(dǎo)致?tīng)I(yíng)養(yǎng)不良、脫水、電解質(zhì)紊亂等并發(fā)癥，甚至嚴(yán)重影響治療方案的執(zhí)行2。（剩余10910字）