膀胱癌患者根治术后自我感受负担状况及其危险因素

Self-perceived burden and the risk factors in patients with bladder cancer after radical resection

目的:观察膀胱癌患者根治术后自我感受负担状况,分析其危险因素,为临床干预提供理论依据与数据支持,改善患者生存质量。方法:应用便利抽样法选择南京鼓楼医院2018年12月至2021年12月收治的102例膀胱癌根治术患者,依据术后3个月自我感受负担情况,将患者分为存在明显负担组和无明显负担组。收集两组基线资料,分析膀胱癌患者根治术后自我感受负担的影响因素,选出独立危险因素建立logistic回归模型,以受试者工作特征(receiver operating characteristic,ROC)曲线观察回归模型对术后出现明显自我感受负担的预测价值。结果:所有患者根治术后自我感受负担量表(Self-Perceived Burden Scale,SPBS)得分为32.59±8.26,81例(79.41%)出现明显自我感受负担,其中17例存在重度负担,53例存在中度负担,11例存在轻度负担;21例(20.59%)无明显负担。两组年龄、工作状态、家庭人均月收入、病理T分期、慢性病、生活自理能力、并发症差异均有统计学意义(均P<0.05)。Logistic回归分析显示:年龄、家庭人均月收入、慢性病、生活自理能力、并发症均为膀胱癌患者根治术后出现明显自我感受负担的独立危险因素(均P<0.05)。ROC曲线分析显示:年龄、家庭人均月收入、慢性病、生活自理能力、并发症5个独立危险因素均对术后出现明显自我感受负担具有一定预测效能,曲线下面积(area under the curve,AUC)分别为0.645、0.681、0.656、0.776、0.643;上述5个独立危险因素建立的logistic回归模型预测术后出现明显自我感受负担的AUC为0.955(95%CI:0.917~0.993,P<0.001)。结论:膀胱癌患者根治术后患者常会出现中重度自我感受负担,危险因素包括年龄、家庭人均月收入、慢性病、生活自理能力、并发症,应用上述危险因素构建的logistic回归模型对术后出现明显自我感受负担具有良好预测价值,可为临床早期干预提供指导。

Objective:To observe the self-perceived burden and the risk factors of patients with bladder cancer after radical operation,and to provide theoretical basis and data support for clinical intervention and improve the quality of life of patients.Methods:Convenience sampling method was used to select 102 patients with radical bladder cancer who were admitted in Nanjing Drum Tower Hospital from December 2018 to December 2021.According to the self-perceived burden 3 months after the operation,the patients were divided into an obvious burden group and a no obvious burden group.The baseline data of the 2 groups were collected to analyze the influencing factors of self-perceived burden in patients with bladder cancer after radical resection,independent risk factors were selected to establish a logistic regression model,and the receiver operating characteristic(ROC)curve was used to observe the predictive value of the regression model for obvious self-perceived burden after the surgery.Results:The SelfPerceived Burden Scale(SPBS)score of all patients was 32.59±8.26,and 81(79.41%)had obvious self-perceived burden,including 17 with severe burden,53 with moderate burden,and 11 with mild burden;21(20.59%)with no obvious burden,were classified as the no obvious burden group.There were statistically significant differences in age,work status,monthly household income per capita,pathological T stage,chronic disease,self-care ability,and complications between the 2 groups(all P<0.05).Logistic regression analysis showed that age,per capita monthly income of family,chronic diseases,self-care ability,and complications were all independent risk factors for obvious self-perceived burden in patients with bladder cancer after radical surgery(all P<0.05).The ROC curve analysis showed that the 5 independent risk factors screened out,including age,per capita monthly income of the family,chronic diseases,self-care ability,and complications,which had a certain predictive effect on the apparent self-perceived burden after the surgery.The area under the curves(AUC)were respectively 0.645,0.681,0.656,0.776,0.643.The logistic regression model established by the above 5 independent risk factors predicted the AUC of obvious self-perceived burden after the surgery was 0.955(95%CI 0.917 to 0.993,P<0.001).Conclusion:Patients with bladder cancer often have moderate to severe self-perceived burden after radical resection.Risk factors include age,per capita monthly income of the family,chronic diseases,self-care ability,and complications.The logistic regression model constructed using the above risk factors has good predictive value for the obvious self-perceived burden after surgery,and can provide guidance for early clinical intervention.