晚期恶性肿瘤与抑郁的相关性研究

发布时间：2018-04-04 02:37

本文选题：肿瘤相关性抑郁　切入点：氟西汀　出处：《大连医科大学》2014年硕士论文

【摘要】：目的：观察223例晚期恶性肿瘤患者抑郁的发病情况及其影响因素,以及氟西汀对肿瘤相关性抑郁患者的免疫功能及生活质量的影响。方法：本研究选择2012年4月至2014年3月期间在大连医科大学附属第一医院肿瘤科住院的223例患者为研究对象,均经病理学及影像学确诊为晚期恶性肿瘤,在确诊前无抑郁病史。用DSM-Ⅳ(Diagnostic and Statistical Manual Ⅳ)进行恶性肿瘤相关性抑郁的诊断,并根据汉密顿抑郁量表(Hamilton Depression Scale,HAMD)(24项)法进行抑郁情况评估,诊断为晚期恶性肿瘤相关性抑郁的患者共94例,无抑郁的患者129例,抑郁发病率为42.2%,其中诊断为轻-中度肿瘤抑郁84例,重度10例。将94例晚期恶性肿瘤相关性抑郁患者随机分为2组：以47例为对照组,予以化疗；以47例为研究组,予以化疗加抗抑郁治疗。为排除肿瘤病人被诊断为癌症之后最初的应激心理反应,故氟西汀治疗均在抑郁症确诊3周以后进行。抗抑郁治疗：氟西汀口服20mg/d,持续口服至完成2周期化疗,同时按照患者的自身情况进行正常的抗肿瘤治疗。采用SPSS17.0软件,对所有数据进行统计学分析,统计数据均以均数±标准差表示,抑郁组与无抑郁组中性别、年龄、发病部位、KPS评分、化疗方案、知情情况及文化程度采用卡方检验。研究组中自身治疗前后比较采用配对T检验,研究组与对照组组间比较采用两独立样本T检验,以汉密顿抑郁量表(24项)、肿瘤生活质量表中文版(QLQ-C30)以及T细胞亚群为观察指标,以P0.05为差异有统计学意义。结果：在抑郁组和无抑郁组中,晚期恶性肿瘤患者抑郁发病情况与性别、KPS评分、化疗方案种类、知情情况、文化程度存在相关性,有统计学差异(P0.05),与年龄及发病部位无相关性,无统计学差异(P0.05) 在研究组中,治疗前后QLQ-C30评分示：生活质量评分在躯体、角色、情绪功能及整体生活质量方面上升,有统计学差异(P0.05),在疲乏、疼痛、失眠及食欲减退症状中评分下降,有统计学差异(P0.05),在认知功能、社会功能、恶心呕吐、气短、便秘、腹泻及经济困难方面无统计学差异(P0.05)；HAMD评分下降,有统计学差异(P0.05)；T细胞亚群检测中,CD3+、CD4+、CD4+/CD8+较治疗前升高,有统计学差异(P0.05),CD8+较治疗前升高,但无统计学差异(P0.05) 在对照组中,T细胞亚群检测治疗前与治疗后比较：CD3+、 CD4+/CD8+下降,有统计学差异(P0.05),提示化疗可减低患者的免疫功能,CD4+、CD8+无统计学差异(P0.05)；HAMD评分有所升高,但无统计学差异(P0.05) 研究组和对照组进行比较,研究组中CD3+、CD4+、CD4+/CD8+较对照组中有提高,有统计学差异(P0.05),CD8+较对照组无统计学差异(P0.05)；在情绪功能、失眠、疼痛、食欲减退及整体生活质量方面较对照组改善明显,有统计学差异(P0.05) 结论：晚期恶性肿瘤患者肿瘤相关性抑郁在女性、文化程度低、KPS评分低、化疗方案种类多、知情者中发病率高,应重视对其进行心理评估,及早发现患者抑郁情况并及时治疗,从而提高晚期恶性肿瘤患者生活质量。口服氟西汀治疗能在一定程度上改善肿瘤相关性抑郁患者抑郁情况,提高其生活质量,改善免疫功能,延长生存期。
[Abstract]:Objective : To investigate the incidence of depression in 223 patients with advanced malignant tumor and its influencing factors , as well as the effects of fluoxetine on the immune function and quality of life of patients with tumor - related depression .

Methods : From April 2012 to March 2014 , 223 patients who were hospitalized in the First Affiliated Hospital of Dalian Medical University were diagnosed as advanced malignant tumors .
All the data were analyzed statistically by SPSS 17.0 software . Statistical analysis was performed on all the data after 3 weeks of diagnosis of depression . Statistical analysis was performed on all the data by SPSS 17.0 software .

Results : In the depression group and the non - depression group , the incidence of depression in patients with advanced malignant tumor was correlated with the sex , the kps score , the type of chemotherapy regimen , the knowledge and the degree of culture . There was a statistical difference ( P0.05 ) . There was no correlation between the age and the morbidity , and there was no statistical difference ( P0.05 ) .

In the study group , the scores of QLQ - C30 before and after treatment showed that the QOL scores increased in the aspects of physical , role , emotional function and overall quality of life ( P0.05 ) . There was statistical difference ( P0.05 ) . There was no statistical difference in cognitive function , social function , nausea and vomiting , shortness of breath , constipation , diarrhea and economic difficulties ( P0.05 ) ;
There was a significant difference in the scores ( P0.05 ) .
CD3 + , CD4 + , CD4 + / CD8 + were significantly higher in T cell subgroup than before treatment ( P0.05 ) , CD8 + increased before treatment , but there was no statistical difference ( P0.05 ) .

In the control group , CD3 + , CD4 + / CD8 + decreased before and after treatment : CD3 + , CD4 + / CD8 + decreased significantly ( P0.05 ) , suggesting that chemotherapy could reduce the immune function , CD4 + and CD8 + in patients ( P0.05 ) .
There was an increase in the scores , but there was no statistical difference ( P0.05 ) .

Compared with the control group , the CD3 + , CD4 + , CD4 + / CD8 + in the study group were higher than those in the control group ( P0.05 ) .
There was significant difference in emotion function , insomnia , pain , anorexia and overall quality of life ( P0.05 ) .

Conclusion : In patients with advanced malignant tumor , the relationship of tumor - related depression is low in women , low in degree of culture , low in kps score , more in chemotherapy regimen and high in patients with knowledge . It should be emphasized that depression can be improved in patients with advanced malignant tumor , and the quality of life can be improved .

【学位授予单位】：大连医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R730;R749.4

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