常见低度恶性皮肤原发T细胞淋巴瘤患者与主要照顾者焦虑抑郁情况及影响因素

Anxiety-depression and Influencing Factorsin Patients and Family Caregivers with Common Low-grade Malignant Primary Cutaneous T-cell Lymphoma

目的探讨常见低度恶性皮肤原发T细胞淋巴瘤患者焦虑抑郁心理障碍的发生率及分析可能的影响因素;并分析该类疾病患者和主要照顾者的心理状况及其相关性;以医院焦虑抑郁量表(hospital Anxiety&Depression scale,HADS)为标准量表,探讨心理痛苦温度计(distress thermometer,DT)的临界值、敏感性与特异度。方法应用HADS、DT和患者一般情况及疾病相关情况问卷进行调查。结果30%的患者和35%的主要照顾者存在焦虑抑郁症状。单因素分析表明皮损面积、受教育程度、患者对疾病了解程度、病情进展情况与患者焦虑抑郁症状的发生相关(P<0.01)。多因素分析显示皮损面积大于10%、受教育程度为大学本科以下和认为病情进展情况越严重是出现焦虑抑郁症状的危险因素(P<0.05)。比较患者及主要照顾者的调查结果发现两者各项评分存在相关性。患者及主要照顾者DT评分分别在临界值取4分及5分时,敏感性和特异性最高。结论常见低度恶性皮肤原发T细胞淋巴瘤患者及主要照顾者焦虑抑郁症状发生率较高并且存在相关性。影响患者焦虑抑郁症状发生的主要因素涉及心理、生理、社会多方面。建议同时关注患者及主要照顾者心理情况,必要时给予一定治疗。在国内使用DT评价低度恶性肿瘤患者及主要照顾者焦虑抑郁情况时,可参考上述临界值。

Objectives It aims to investigate the rate of occurrence of anxiety and depression among the patients of primary cutaneous T-cell lymphoma with the possible influential factors, analyzing the psychological status and relevance of the patients and family caregivers, and study the cut-off point of DT, sensitivity and specificity based on the HADS. Methods The questionnaire with HADS and DT, general situations of patients and related disease conditions is used for research. Results Thirty percent of the patients and thirty five percent of family caregivers have anxiety and depression. Univariate analysis shows that anxiety and depression symptoms are associated with the lesion area, educational background, the understanding of the disease and disease progression （ P 〈 0. 01 ） . And a logistic repression analysis shows that anxiety and depression symptoms are influenced by the lesion area, educational background and disease progression（P 〈 0. 05）. The psychological status between patients and family caregivers are closely related to each other. When the patients and family caregivers＇ cut-off point of DT is 4 or 5, the specificity and sensitivity is the highest. Conclusion There is a high prevalence of anxiety-depression in the patients and family caregivers with high rate of ocurrence. The influential factors include psychological, biological and social factors. It is suggested to pay attention to the psychological status of patients and family caregivers with certain treatment when necessary. When DT might be efficacious for screening for anxiety and depression in primary cutaneous T-cell lymphoma patients at home, the above cut-off point can be referenced.