难治性化疗所致恶心呕吐的列线图预测模型建立与评估

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中图分类号R730.6；R975+.4 文献标志码A 文章编号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

化疗所致恶心呕吐（chemotherapy-inducednauseaandvomiting，CINV）是化疗过程中常见的不良反应之一，不仅会影响患者的生存质量和治疗依从性，还可能导致营养不良、脱水、电解质紊乱等并发症，甚至严重影响治疗方案的执行2。（剩余10910字）