乳腺癌患者化疗相关认知障碍及其与抑郁情绪关系的研究

发布时间：2018-01-05 09:05

  本文关键词：乳腺癌患者化疗相关认知障碍及其与抑郁情绪关系的研究　出处：《安徽医科大学》2015年硕士论文　论文类型：学位论文

  更多相关文章： 化疗 抑郁 认知障碍 乳腺癌

【摘要】：目的了解乳腺癌术后患者经过六周期标准方案化疗后抑郁的发生状况,了解化疗前后记忆、注意、执行功能等认知功能的变化,并进一步探讨化疗后患者抑郁情绪与其认知障碍的关系。方法首先,应用抑郁自评量表(SDS)筛选出2013年10月至2014年8月在我院肿瘤科及乳腺外科就诊的68例乳腺癌术后未合并抑郁情绪的患者;其次,采用成套认知神经心理学量表对入组患者进行化疗前认知神经心理学评分,并记录入组患者的一般资料及乳腺癌的临床资料;最后,在六周期标准方案化疗后2周内再次对入组患者进行抑郁自评量表及认知神经心理学方面评估。成套认知神经心理学量表包括简易精神状况量表(mini-mental state examination,MMSE)、词语流畅性测验(verbal fluency test,VFT)、听觉词语学习测验表(auditory words learn test,AVLT)、数字广度试验(digit span,DS)和连线测验(trail making test,TMT)。63例乳腺癌患者完成化疗前后全部问卷调查。应用SPSS16.0对数据进行录入和分析,分析方法包括描述性统计分析、两独立样本t检验、pearson相关分析等。结果①与化疗前比较,化疗后患者在MMSE(27.84±1.73 vs.26.19±1.77,P=0.000)、数字广度倒背(4.40±1.02 vs.3.60±0.99,P=0.000)、AVLT3(7.06±0.78vs.6.76±0.86,P=0.002)、AVLT4(3.41±0.99 vs.2.73±0.99,P=0.000)、AVLT5(2.81±0.76 vs.2.16±0.68,P=0.000)、AVLT6(9.19±1.11 vs.8.22±1.16,P=0.000)、TMTA(52.25±1.68 vs.53.54±1.89,P=0.000)和TMTB(98.94±1.89 vs.105.16±2.03,P=0.000)得分降低,差异有统计学意义(均P0.05);在SDS得分升高,差异有统计学意义(37.44±6.74 vs.48.31±13.09,P0.05)。②本研究中共有63例患者完成问卷调查,其中29例患者化疗后合并抑郁情绪,34例患者不合并抑郁情绪,抑郁发生率为46.03%。与化疗后未合并抑郁患者比较,抑郁组在MMSE、VFT(动物)、VFT(水果)、AVLT1、AVLT4~AVLT6、数字广度倒背和TMTB成绩差异均有统计学意义(分别为t=-5.202、-2.591、-2.435、-3.358、-3.047、-5.822、-3.707、-2.231、3.597;均P0.05),而在AVLT2、AVLT3、数字广度顺背和TMTA评分成绩差异无统计学意义(分别为t=-1.251、-1.214、-1.683、0.445,均P0.05)。③抑郁与MMSE、VFT(水果)、AVLT3、数字广度顺背、数字广度倒背、TMTB得分呈中度负相关,差异有统计学意义(分别为r=-0.398、-0.439、-0.441、-0.425、-0.429、-0.483,均P0.05)。结论①乳腺癌患者术后化疗后存在不同程度的认知功能受损,表现为总体认知功能、记忆力、注意力及执行功能的改变。②乳腺癌术后化疗后患者抑郁发生率较高,需要临床医护工作者高度重视。③乳腺癌化疗后合并抑郁患者的总体认知功能、记忆力、注意力、语言能力、执行功能下降情况更为严重,并且抑郁情绪与总体认知功能、注意力和执行能力存在相关性,进一步说明抑郁情绪会加重乳腺癌患者化疗相关认知障碍。
[Abstract]:Objective to understand the prevalence of patients after six cycles of depression after standard chemotherapy after breast cancer surgery, understand the changes before and after chemotherapy and memory, attention, executive function and other cognitive functions, and to further explore the relationship after chemotherapy in patients with depression and cognitive impairment. Methods firstly, using self rating Depression Scale (SDS) were selected to October 2013 in August 2014 with depression in 68 cases of breast cancer, and breast surgery in our hospital treatment of tumor patients after; secondly, the cognitive neuropsychological scale of the patients before chemotherapy cognitive neuropsychology score and clinical data records into groups of patients with general information and breast cancer; finally, in six cycles of chemotherapy after 2 weeks again for the patients by self rating depression scale and cognitive neuropsychological assessment. Cognitive neuropsychological scale including Jian Yijing God Status Scale (Mini-Mental State Examination, MMSE), verbal fluency test (verbal fluency, test, VFT), auditory verbal learning test table (auditory words learn test, AVLT), digital span test (digit span, DS (Trail Making) and trail making test test, TMT) before and after chemotherapy all questionnaires completed.63 cases of breast cancer patients. The application of SPSS16.0 for data analysis, analysis methods including descriptive statistical analysis, two independent samples t test, Pearson correlation analysis. Results compared with before chemotherapy, after chemotherapy in patients with MMSE (27.84 + 1.73 vs.26.19 + 1.77, P=0.000), digital span (4.40 + 1.02 vs.3.60 + 0.99, P=0.000), AVLT3 (7.06 + 0.78vs.6.76 + 0.86, P=0.002), AVLT4 (3.41 + 0.99 vs.2.73 + 0.99, P=0.000), AVLT5 (2.81 + 0.76 vs.2.16 + 0.68, P=0.000), AVLT6 (9.19 + 1.11 vs.8.22 + 1.16, P=0.000), TMTA (52.25 + 1.68 + 1.89 vs.53.54 P=0.000), and TMTB (98.94 + 1.89 + 2.03 vs.105.16, P=0.000) score decreased, the difference was statistically significant (P0.05); increase in the SDS score, the difference was statistically significant (37.44 + 6.74 vs.48.31 + 13.09, P0.05). In this study a total of 63 patients completed the questionnaire, which combined with depression 29 cases of patients after chemotherapy, 34 cases of patients with depression, the depression rate was 46.03%. and after chemotherapy without depression, the depression group in MMSE, VFT (animal), VFT (fruit), AVLT1, AVLT4~AVLT6, digital span and TMTB score differences were statistically significant (respectively t=-5.202, -2.591 -2.435, -3.358, -3.047, -5.822, -3.707, -2.231,3.597, P0.05);, and in AVLT2, AVLT3, digital span difference back and TMTA scores had no statistical significance (t=-1.251, -1.214, -1.683,0.445, P0.05). The depression and MMSE, VFT, AVLT3 (fruit), digital broadcasting Is along the back, digital span, TMTB scores were negatively correlated, the difference was statistically significant (r=-0.398, -0.439, -0.441, -0.425, -0.429, -0.483, P0.05). The postoperative breast cancer patients after chemotherapy conclusion have cognitive dysfunction at various levels, performance for the overall cognitive function and memory. Attention and executive function change. The chemotherapy of postoperative breast cancer patients after the incidence of depression is high, clinical medical workers need attention. The chemotherapy after breast cancer with general cognitive function, depression, memory, attention, language, executive function decline is more serious, and depression and general cognitive function, existence correlation between attention and executive ability, further explained that depression can aggravate the cognitive disorder of chemotherapy in patients with breast cancer.

【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R737.9

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