非小细胞肺癌患者在程序性死亡受体1单抗联合化疗期间的心理症状群分组特征及预测指标分析

Grouping characteristics and predictive indexes of psychological symptoms in patients with non-small cell lung cancer during programmed cell death protein 1 monoclonal antibody combined with chemotherapy

目的探讨非小细胞肺癌患者在程序性死亡受体1(PD-1)单抗联合化疗期间心理状态症状群分组特征,并分析不同症状群特征的预测指标。方法本研究为横断面研究,采用问卷调查的形式,便利抽样法选取2019年3月至2021年3月于甘肃省武威肿瘤医院171例采用PD-1单抗联合化疗的非小细胞肺癌患者作为研究对象,采用一般资料调查表、匹兹堡睡眠质量指数、癌因性疲乏调查量表、医院焦虑抑郁量表、癌症患者体力活动测定量表、心理痛苦温度计、肺癌患者生命质量测定量表进行调研。基于非小细胞肺癌患者在治疗期间躯体疲乏、焦虑状况、抑郁状况、睡眠质量、心理痛苦程度的测评结果拟合潜类别模型。对量表结果进行潜类别模型分析建立类别组模型,采用逻辑回归分析比较各组患者人口学特征及疾病分期、分型、性格特点等,探索不同类别组间的预测指标。结果依据非小细胞肺癌患者在PD-1单抗联合化疗期间疲乏、焦虑、抑郁、睡眠障碍、心理痛苦程度等症状群表现分为2种不同的类别,分别命名为高心理症状组占44.44%(76/171)和低心理症状组占55.56%(95/171)。低心理症状组肺癌患者的生命质量测定量表中的生理状况、社会/家庭状况、情感状况、功能状况、附加关注维度以及体力活动得分分别为(11.28±5.62)、(17.57±4.31)、(11.14±3.27)、(14.83±5.24)、(14.76±4.03)、(88.61±17.38),高于高心理症状组的(17.82±4.43)、(10.76±3.63)、(18.62±6.06)、(9.34±3.13)、(26.26±3.23)、(58.04±15.41)分,差异均有统计学意义(t值为10.36~15.84,均P<0.05)。单因素Logistic回归分析结果表明,性格特点[外向型(OR=0.08,95%CI 0.03~0.23,P<0.05),中间型(OR=0.16,95%CI 0.08~0.33,P<0.05)],癌症患者体力活动(OR=0.91,95%CI 0.88~0.93,P<0.05)为预测区分高心理症状组的预测指标。结论非小细胞肺癌者在进行PD-1单抗联合化疗期间心理症状群存在明显的分类特征,在进行治疗期间根据不同的心理症状特征,给予不同的心理干预和护理关怀,以提高患者的生命质量。

Objective To investigate the grouping characteristics of psychological state symptom clusters in patients with non-small cell lung cancer during programmed death 1(PD-1)monoclonal antibody combined with chemotherapy,and to analyze the predictors of different symptom cluster characteristics.Methods This study was a cross-sectional study.In the form of a questionnaire,171 patients with non-small cell lung cancer who received PD-1 monoclonal antibody combined with chemotherapy in Gansu Wuwei Tumor Hospital from March 2019 to March 2021 were selected as the research object by convenient sampling method.The general data questionnaire,Pittsburgh Sleep Quality Index,Cancer-Related Fatigue Survey Scale,Hospital Anxiety and Depression Scale,Physical Activity Measurement Scale for Cancer Patients,Distress Thermometer,and Quality of Life Measurement Scale for Lung Cancer Patients were used for investigation.The latent class model was fitted based on the evaluation results of physical fatigue,anxiety,depression,sleep quality and psychological distress in patients with non-small cell lung cancer during treatment.Latent class model analysis was performed on the scale results to establish a category group model.Logistic regression analysis was used to compare the demographic characteristics,disease stage,classification,and personality characteristics of patients in each group,and to explore the predictive indicators between different categories.Results According to the symptoms of fatigue,anxiety,depression,sleep disorder and psychological distress in patients with non-small cell lung cancer during PD-1 monoclonal antibody therapy combined with chemotherapy,they were divided into two different categories.The group with high psychological symptoms accounted for 44.44%(76/171)and the group with low psychological symptoms accounted for 55.56%(95/171).The scores of physiological status,social/family status,emotional status,functional status,additional attention and physical activity in the quality of life scale of lung cancer patients with low psychological symptoms were 11.28±5.62,17.57±4.31,11.14±3.27,14.83±5.24,14.76±4.03 and 88.61±17.38,respectively.The scores were higher than those in the high psychological symptom group 17.82±4.43,10.76±3.63,18.62±6.06,9.34±3.13,26.26±3.23,58.04±15.41,the differences were statistically significant(t values were 10.36-15.84,all P<0.05);logistic regression analysis showed that personality traits[extroverted(OR=0.08,95%CI 0.03-0.23,P<0.05),intermediate(OR=0.16,95%CI 0.08-0.33,P<0.05)]and physical activity in cancer patients(OR=0.91,95%CI 0.88-0.93,P<0.05)were predictors for distinguishing high psychological symptom group.Conclusions There are obvious classification characteristics of psychological symptom clusters in patients with non-small cell lung cancer during PD-1 monoclonal antibody combined with chemotherapy.Different psychological interventions and nursing care are given according to different psychological symptom characteristics during treatment to improve the quality of life of patients.