本研究利用單一教學醫院之資料，分析乳癌及 NHL 病人在臨床上嗜中性白血 球相關事件的發生率及 G-CSF 的使用狀況。再使用多變項邏輯式迴歸分析和 GEE 分析預防性使用 G-CSF 對於嗜中性白血球低下之相關事件的影響，並分析其他可 能影響嗜中性白血球低下的相關因子，供醫師做未來評估嗜中性白血球低下之高 危險群的參考。
在此教學醫院中，乳癌及 NHL 病人發生嗜中性白血球低下之相關事件發生率 若以人為單位分別是 47%及 79%，以週期為單位分別是 13%及 40%，嗜中性白血 球低下之相關事件皆以 NHL 的發生率為最高。G-CSF 初級預防及次級預防的平均 使用天數，在乳癌病人的化學治療週期中，分別為 4.9±2.2 天與 3.7±1.5 天；NHL 病人的化學治療週期，分別為 2.9±0.3 天及 3.1±0.5 天，與其他研究相比使用天數 稍短，且比臨床試驗中所用之 10-14 天短。針對預防性使用 G-CSF 之平均天數較 短，建議可與臨床工作者討論在病人使用化學治療時，其預防性使用 G-CSF 之開 方天數的考量及顧慮。
本研究並無發現預防性使用 G-CSF 對於乳癌或 NHL 病人的化學治療週期有保 護的效果，其可能原因為 G-CSF 同時使用在適合及不適合的病人身上，造成預防 性使用 G-CSF 的效果不明顯。另外本研究預防性使用 G-CSF 大多為 3 天，無法分 析使用天數的差異對於嗜中性白血球低下之相關事件的影響。因此未來如果能收 集更多醫院的資料，分析出最適合預防性使用 G-CSF 的研究族群(例如：使用高 FN 風險的化學治療處方之病人)及預防性使用 G-CSF 的最佳使用天數，對於將來 健保給付條款也能有所影響。
本研究發現使用高 FN 風險之化學治療處方為增加乳癌病人化學治療週期中 嗜中性白血球低下風險的危險因子；增加 NHL 病人化學治療週期中嗜中性白血球 低下風險的危險因子則為血紅素<12 g/dL。由於本研究乳癌及 NHL 病人影響嗜中 性白血球低下之危險因子有所差異，故當乳癌病人在使用高 FN 風險的化學治療處
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方或 NHL 病人在使用化學治療藥物前血紅素低於 12 g/dL，可能為發生嗜中性白 血球低下之高危險群，應特別提醒醫師注意。
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Alcohol Tobacco
Tumor type/Stage*
Liver disease
□ Liver cirrhosis*child-pugh A / B / C
□ HBV □ HCV
□ Acites □ Encephalopathy
Renal disease
□ ARF* □ CRF (stage: ) □ Dialysis: HD /PD / others
89
Charlson comorbidity index:
□ Cerebrovascular disease □ Dementia □ Chronic pulmonary disease
□ Connective tissue disease □ Ulcer disease □ Mild liver disease
Cirrhosis w/o portal hypertension Chronic hepatitis
□ Diabetes
□ Diabetes with end organ damage
□ Hemiplegia □ Moderate or severe renal disease Dialysis, transplant, uremia, Scr>3 mg/dL
□ Any tumor □ Leukemia □ Lymphoma
□ Moderate or severe liver disease Cirrhosis+portal hypertension +/-variceal bleeding
□ MI □ CHF
□ Metastatic solid tumor □ AIDS
個數：42C/T Regimen D1:
Drug Dose Dose/Frequency Start Day
1.
Location Dose
1.
Drug Dose Frequency Start day End day Duration Indication
1. Lenograstim Mcg
90
Lab (from C/T D1 until ANC recover and discontinued G-CSF or discharge)
[Baseline] Date : Date
Scr/BUN Hb Hb
eGFR PLT PLT
T-bil/D-bil WBC WBC
AST/ALT Seg/Band Seg/Band
LDH ANC ANC
Neutropenia date* WBC count
FN* □ Y / □ N
91
Drug Dose Dose/Frequency Start Day
1.
Location Dose
1.
Planned date: Actual date: △(Planned – Actual)
Dose reduction (□ Y / □ N )
Drug Dose Frequency Start day End day Duration Indication
1. Lenograstim Mcg □Primary
92