[摘 要] 目的：探讨程序性死亡蛋白1（PD-1）抑制剂与恶性黑色素瘤患者癌性疲劳（CRF）之间的关系及其影响因素。方法： 选取2019年4月至2024年4月期间在济南市人民医院接受治疗的100例恶性黑色素瘤患者作为研究对象，使用中文版Piper疲劳 量表评估这些患者在接受首次PD-1抑制剂治疗前后3个月内的疲劳状况。结果：使用PD-1抑制剂前后的患者疲劳评分存在显 著差异（P < 0.001）。单变量分析发现，性别、吸烟史、肿瘤位置以及使用的PD-1抑制剂类型对于疲劳程度没有明显影响（均 P > 0.05），而与年龄、疾病分期、贫血状态、白细胞减少症、继发性甲状腺机能减退（甲减）、继发性肾上腺皮质醇功能减退（AI）、继 发性促肾上腺皮质激素降低（P < 0.05或P < 0.01或P < 0.001）相关联。进一步的多变量回归分析揭示，继发性甲减、继发性AI、 贫血、白细胞减低是导致此类患者出现严重CRF的关键独立风险因素（均P < 0.05）。结论: PD-1抑制剂的不良反应继发性甲 减、继发性AI、贫血、白细胞减低是恶性黑色素瘤患者CRF的独立风险因素。

[Abstract] Objective: To explore the relationship between programmed death-1 (PD-1) inhibitors and cancer-related fatigue (CRF) in patients with malignant melanoma, and to identify associated influencing factors. Methods: A total of 100 patients with malignant melanoma treated at Jinan People's Hospital between April 2019 and April 2024 were included as study subjects. The Chinese version of the Piper Fatigue Scale was used to evaluate patients' fatigue levels within three months before and after the initiation of PD-1 inhibitor therapy. Results: There was a significant difference in CRF score before and after PD-1 inhibitor treatment (P < 0.001). Univariate analysis showed no significant association between fatigue severity and factors such as gender, smoking history, tumor site, or PD-1 inhibitor type (all P > 0.05). However, age, tumor stage, anemia, leukopenia, secondary hypothyroidism, secondary adrenal insufficiency (AI), and secondary adrenocorticotropic hormone deficiency (P < 0.05 or P < 0.01 or P < 0.001) were significantly associated with CRF. Multivariate regression analysis identified secondary hypothyroidism, secondary AI, anemia, and leukopenia as independent risk factors for severe CRF in patients with malignant melanoma (all P < 0.05). Conclusion: Adverse reactions of PD-1 inhibitors, including secondary hypothyroidism, secondary AI, anemia, and leukopenia, are independent risk factors for CRF in patients with malignant melanoma.