甲状腺结节患者心理状况及生命质量研究

发布时间：2018-06-24 00:23

本文选题：甲状腺结节 + 甲状腺微小乳头状癌　；参考：《山东大学》2017年硕士论文

【摘要】：目的:本研究旨在了解甲状腺结节患者,特别是甲状腺微小乳头状癌(PTMC)患者的心理状况和生命质量及相关影响因素,同时研究患者心理状况、生命质量、人格特征及医学应对方式之间的相互关系。方法1.研究对象:2016年10月～2016年12月在山东大学齐鲁医院内分泌科及甲状腺外科门诊及住院的术前甲状腺结节患者207例为甲状腺结节组,211例来源于健康体检人群、本院职工及进修实习人员的健康人作为健康对照组(Normal,N),签署知情同意书后确立为研究对象。甲状腺结节组依照B超及细针穿刺细胞学结果分为:良性组(Benign,B),甲状腺微小乳头状癌(PTMC)组,结节1cm的非甲状腺微小乳头状癌(N-PTMC)组。2.研究方法:采用Zung焦虑自评量表(SAS)、Zung抑郁自评量表(SDS)、SF-36健康调查量表(SF-36)、艾森克人格问卷简式量表中国版(EPQ-RSC)、医学应对问卷(MCMQ)和一般情况调查表进行问卷调查,以了解甲状腺结节患者的心理状况和生命质量及相关影响因素,同时探讨患者心理状况、生命质量、人格特征及医学应对方式之间的相互关系。3.数据处理和统计分析:采用SPSS21.0软件进行统计分析,差异显著性的检验标准为0.05,p0.05认为差异具有统计学意义。两组人员的匹配情况采用卡方检验。利用一元线性回归和多元逐步回归分析差异具有统计学意义的因素;利用Spearman相关分析患者心理状况、生命质量、人格特征及医学应对方式之间的相关性。结果1.甲状腺结节患者焦虑发生率为10.63%(22/207),抑郁发生率13.04%(27/207)。健康对照组焦虑和抑郁发生率均为1.90%(4/211)。甲状腺结节组SAS、SDS评分均高于健康对照组,差异具有统计学意义(p0.05)。影响甲状腺结节患者焦虑情绪的因素有:年龄、月收入、生命质量、人格特征,年龄小、收入低、生命质量差、神经质特质明显,患者焦虑情绪越严重。影响甲状腺结节患者抑郁症状的因素有生命质量、人格特征、月收入、应对方式,生命质量差、神经质特质突出、收入低以及屈服应对方式明显的患者抑郁情绪更明显。甲状腺结节患者的焦虑与抑郁情绪呈正相关,患者的焦虑、抑郁情绪与生命质量、外倾及掩饰特质呈负相关,与神经质特质、回避及屈服维度呈正相关。2.甲状腺结节患者生命质量水平下降,且以心理健康相关生命质量下降为主。影响甲状腺结节患者生命质量的因素有:年龄、婚姻、月收入、结节大小、心理状况、人格特征。年龄小、已婚、收入低、心理状况好、性格外向情绪稳定,则生命质量越高。甲状腺结节患者生命质量与外倾及掩饰特质呈正相关,与神经质特质、回避及屈服维度呈负相关。3.PTMC患者、良性结节患者、N-PTMC患者焦虑发生率分别为11%(11/100)、9.62%(5/52)、10.9%(6/55);抑郁发生率分别为 13%(13/100)、11.54%(6/52)、14.55%(8/55);健康对照组焦虑和抑郁发生率均为1.90%(4/211)。3组患者SAS与SDS评分较健康人高,3组患者之间SAS与SDS评分差异无统计学意义。影响PTMC患者焦虑症状的因素有躯体疼痛、精神健康,躯体疼痛程度重、精神健康评分低,焦虑情绪越严重。影响PTMC患者抑郁症状的因素有躯体疼痛、神经质、屈服维度,躯体疼痛程度重、神经质维度和屈服维度评分高,抑郁情绪越严重。PTMC患者的焦虑与抑郁情绪呈正相关;焦虑、抑郁情绪与生命质量、外倾及掩饰特质呈负相关,与神经质特质、回避及屈服维度呈正相关。4.3组甲状腺结节患者生命质量与健康人相比差异具有统计学意义,结节患者生命质量下降,且以心理健康相关的生命质量下降为主。PTMC、N-PTMC、良性组之间生命质量差异无统计学意义。影响PTMC患者生命质量的因素有:婚姻、诊断时长、心理状况、人格特征、医学应对方式。未婚、诊断时长短、心理状况差、性格不稳定、屈服应对方式为主的患者生命质量更差。PTMC患者的生命质量与外倾特质呈正相关,与神经质特质呈负相关。结论1.部分甲状腺结节患者包括PTMC患者存在焦虑和抑郁情绪,并受患者生命质量、人格、应对方式等因素影响。在治疗过程中辅以适当的心理干预以改善患者负性情绪具有重要意义。2.甲状腺结节患者包括PTMC患者存在生命质量水平下降,并受多种因素影响;患者生命质量以心理健康相关的生命质量下降为主,改善患者的生命质量应重视患者心理状况的改善。3.甲状腺结节患者包括PTMC患者以积极应对方式为主,患者的应对方式与其心理状况和生命质量具有相关性。采取积极的应对方式有利于改善患者心理状况、提升生命质量。4.PTMC组、非PTMC组以及良性结节组之间患者的心理状况、生命质量均无明显差异,甲状腺结节的性质、大小等对患者心理状况与生命质量的影响无明显差异。临床上诊疗方案的制定在考虑结节生物学行为的基础上,辅以适当的心理干预具有重要意义。
[Abstract]:Objective: the purpose of this study was to understand the psychological status, quality of life and related factors in patients with thyroid nodules, especially small thyroid papillary carcinoma (PTMC), and to study the relationship between patients' psychological status, quality of life, personality characteristics and medical coping styles. Method 1. subjects: October 2016 to December 2016 207 cases of thyroid nodules in the Department of Endocrinology, the Department of Endocrinology, the thyroid surgery and the hospitalization of the Qilu Hospital in Shandong University were the thyroid nodules, and 211 were from the healthy population. The health control group (Normal, N) was established as the research object after the informed consent book was signed. The group was divided into the benign group (Benign, B), the thyroid micropapillary carcinoma (PTMC) group, the 1cm non thyroid small papillary carcinoma (N-PTMC) group.2. research methods: the Zung anxiety self rating scale (SAS), the Zung depression self rating scale (SDS), the SF-36 health survey scale (SF-36), and the Eysenck personality questionnaire. The Chinese version of the scale (EPQ-RSC), the Medical Coping Questionnaire (MCMQ) and the general situation questionnaire were used to investigate the psychological status, quality of life and related factors of thyroid nodules, and the relationship between the psychological status, quality of life, personality characteristics and medical coping styles of patients with.3. data processing and statistical analysis. Analysis: the statistical analysis was carried out by SPSS21.0 software. The standard of difference significance was 0.05, and P0.05 thought the difference was statistically significant. The matching of the two groups was checked by chi square test. The factors of statistical significance were analyzed by the linear regression and multiple stepwise regression, and the psychological status of the patients was analyzed by Spearman correlation. Results 1. the incidence of anxiety in 1. patients with thyroid nodules was 10.63% (22/207), and the incidence of depression was 13.04% (27/207). The incidence of anxiety and depression in the healthy control group was 1.90% (4/211). The thyroid nodule group was SAS, and the SDS score was higher than that in the healthy control group, the difference was statistically significant ( P0.05). The factors affecting the anxiety of patients with thyroid nodules are age, monthly income, life quality, personality, age, low income, poor quality of life, significant neuroticism and severe anxiety. The factors affecting the depressive symptoms of thyroid nodules are characterized by quality of life, personality, monthly income, coping style, life quality. There was a positive correlation between anxiety and depression in patients with thyroid nodules, and the anxiety and depression of the patients were negatively related to the quality of life, extroversion and disguise, and the.2. thyroid was positively related to the hypothyroidism, avoidance and yield dimensions. The quality of life of the patients with nodules was reduced and the quality of life related to mental health decreased mainly. The factors affecting the quality of life of the thyroid nodules were age, marriage, monthly income, nodule size, psychological status, personality characteristics. Age, marriage, low income, good mental condition, and stable extrovert, the higher the quality of life. The quality of life of patients with adenoid nodules was positively correlated with extroversion and disguise. The incidence of anxiety in.3.PTMC patients with neuroticism, avoidance and yield dimension was 11% (11/100), 9.62% (5/52), 10.9% (6/55) respectively in patients with benign nodules, 13% (13/100), 11.54% (6/52), 14.55% (8/55), and 14.55% (8/55), and healthy control group). The incidence of anxiety and depression were all 1.90% (4/211).3 patients with SAS and SDS scores higher than those of the healthy people. There was no statistical difference between the 3 groups of patients with SAS and SDS scores. The factors affecting the anxiety symptoms of PTMC patients were somatic pain, mental health, somatic pain, low mental health score, and more serious anxiety. It affected PTMC patients' depression. The factors such as somatic pain, neuroticism, yield dimension, heavy somatic pain, high neuroticism and yield dimension, the more depressed mood of.PTMC patients were positively correlated with depression and depression, and anxiety and depression were negatively correlated with quality of life, extroversion and disguise, with neuroticism, avoidance and yield dimension. The quality of life of the patients with thyroid nodules in the.4.3 group was statistically significant compared with those of the healthy people. The quality of life of the patients with nodules decreased, and the quality of life related to the mental health decreased mainly.PTMC, and the quality of life between the benign groups was not statistically significant. The factors affecting the quality of life of the PTMC patients were: marriage, and the length of diagnosis. Psychological status, personality characteristics, medical coping style, unmarried, poor diagnosis, poor mental condition, unstable character, and poor quality of life, the quality of life of.PTMC patients was positively correlated with extroversion, and negative correlation with neuroticism. Conclusion the 1. part of the thyroid nodules, including PTMC patients, had a coke. Anxiety and depression are influenced by factors such as quality of life, personality, coping style, and other factors. In the process of treatment, appropriate psychological intervention is important to improve patients' negative emotions..2. thyroid nodules, including PTMC patients, have a decline in the quality of life and are affected by a variety of factors; the quality of life of the patients is psychological health. To improve the quality of life and improve the quality of life of the patients, the improvement of the quality of life of the patients should be paid more attention to the improvement of the psychological status of patients with.3. thyroid nodules, including the positive coping style of the patients with PTMC, the coping style of the patients is related to their psychological status and the quality of life. There was no significant difference in the mental condition between the.4.PTMC group, the non PTMC group and the benign nodule group. There was no significant difference in the quality of life between the thyroid nodules and the size of the thyroid nodules. The formulation of the clinical diagnosis and treatment scheme was based on the biological behavior of the nodules, supplemented by the appropriate treatment. Psychological intervention is of great significance.
【学位授予单位】：山东大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R581

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