放射性脑损伤鼻咽癌患者心理状况和生存质量的配对病例对照研究

Psychological Disorders and Quality of Life in Nasopharyngeal Patients with Radiation-induced Brain Injury:A Case Control Study

目的:探讨鼻咽癌放疗后放射性脑损伤对患者心理状况和生存质量的影响。方法:采用简明心理状况测定90项(SCL-90)和世界卫生组织生存质量测定量表简表(WHOQOL-BREF)对46例鼻咽癌放疗后放射性脑损伤患者(病例组)和46例匹配的非放射性脑损伤者(对照组)进行评定,分析两组心理状况和生存质量的差异及其影响因素。结果:两组在年龄、性别、教育程度、放疗后年限、放疗剂量方面差异均无统计学意义(P>0.05)。放射性脑损伤患者在SCL-90的人际关系、抑郁、焦虑、其他(睡眠、饮食)这4个因子的得分均高于对照组,差异有统计学意义(P<0.001);而在WHOQOL-BREF的生理、心理、人际关系3个领域评分低于对照组,差异有统计学意义(P<0.001)。SCL-90总分与WHOQOL-BREF量表的心理领域得分呈负相关(Pearson相关因素分析,P=0.009)。结论:放射性脑损伤不但可引起焦虑、抑郁等心理障碍而且对生存质量也产生较大的负性影响。

Objective： To evaluate the effect of radiation-induced brain injury （ RIBI ） on the psychology and quality of life （ QOL ） of nasopharyngeal carcinoma （ NPC ） patients after radiotherapy. Methods： Psychological assessment was conducted on 46 NPC patients with RIBI （ case group ） and in another 46 NPC patients without RIBI （ control group ） using the Symptom Check List 90 （ SCL-90 ）. The QOL was evaluated in the two groups using the World Health Organization QOL BREF questionnaire （ WHOQOL-BREF ）. The different scores for SCL-90 and WHOQOL-BREF in the two groups and the risk factors of the two rating scales were also investigated. Results： No significant difference was found in age, gender, educational background, radiation dosage, and post-radiation interval between the RIBI and non-RIBI groups （ P 〉 0.05 ）. Compared with the control group, patients with RIBI obtained significantly higher scores in the four factors of SCL-90, i.e., interpersonal, anxiety, and depression, among others （ sleep and diet ）. Significant differences were found between the two groups （ P 〈 0.001 ）. Nevertheless, the patients with RIBI obtained significantly lower score in the WHOQOL-BREF compared with the control group in terms of physical and psychological health, as well as interpersonal relationships, with statistically significant differences （ P 〈 0.001 ）. Gender, age, and educational background were not correlated with the psychological disorder and QOL of patients with RIBI （ P 〉 0.05 ）. The scores for SCL-90 negatively correlated with that for the WHOQOL-BREF （ Pearson＇s correlation, P = 0.009 ）. Conclusion： NPC patients with RIBI exhibit negative emotions and poor QOL. Moreover, negative emotions, such as anxiety and depression, worsen the QOL of NPC patients with RIBI.