肝癌患者抑郁相关因素及其与生活质量的关系

doi:10.3969/j.issn.1004-583X.2022.06.011

摘要/Abstract

摘要：

目的探讨肝癌患者抑郁相关因素及其与患者生活质量的关系。方法纳入2019-2021年于南充市中心医院经病理确诊的肝癌患者67例,根据汉密尔顿抑郁量表(Hamilton Depression Scale,HAMD)评分将患者分为抑郁组和非抑郁组。比较两组临床资料差异。结果 67例患者中23例患有抑郁症(34.3%),抑郁组和非抑郁组在性别、年龄、饮酒、吸烟、能否承担费用、对疾病的知情情况、治疗方法、介入治疗次数等方面差异均无统计学意义(P>0.05),在数字疼痛量表评分、匹兹堡睡眠指数(Pittsburgh sleep quality index, PSQI)评分、汉密尔顿焦虑量表(Hamilton Anxiety Scale,HAMA)评分及肝癌临床分期等方面差异均有统计学意义(P<0.05) 。在生活质量评估方面,两组躯体功能、社会功能、恶心与呕吐、气促、腹泻、便秘等得分差异均无统计学意义(P>0.05),非抑郁组角色功能、情绪功能、认知功能、总体健康状况等得分均高于抑郁组(P<0.05),疲倦、失眠、疼痛、经济状况及食欲丧失等得分均低于抑郁组(P<0.05)。绘制森林图显示,PSQI评分及HAMA评分高是肝癌患者抑郁的危险因素。经多因素线性回归分析发现,是否抑郁对肝癌患者生活质量的影响差异有统计学意义(P<0.05),非抑郁患者的生活质量比抑郁患者高64.164倍。结论 PSQI评分及HAMA评分高是肝癌患者抑郁的危险因素。肝癌合并抑郁患者的生活质量较差,在临床工作中需要预防肝癌患者抑郁症状的出现,以提高患者愈后及生活质量。

关键词: 肝肿瘤, 抑郁, 生活质量, 危险因素

Abstract:

Objective To explore the related factors of depression and corresponding correlations with quality of life in patients with hepatocellular carcinoma (HCC). Methods Sixty seven patients with HCC diagnosed by Nanchong Central Hospital by means of pathology from 2019 to 2021 were divided into the depression group and non-depression group according to scores of Hamilton Depression Scale (HAMD). The differences in clinical data of patients in two groups were compared. Results Twenty three (34.3%) out of 67 patients suffered from depression, the differences in the gender, age, marriage, education level, alcohol consumption, smoking, affordability, knowledge of disease, therapeutic method, number of interventional treatment between groups weren’t statistically significant (P>0.05), and the differences in digital pain scale score, Pittsburgh sleep quality index(PSQI) scores, HAMA scores and clinical staging of HCC were statistically significant (P<0.05). The differences in the quality of life assessment, physical function, social function, nausea & vomiting, shortness of breath, diarrhea, constipation, scores of patients in groups weren’t statistically significant (P>0.05). The scores of role function, emotional function, cognitive function, general health in the non-depression group were higher than those in the depression group (P<0.05), and the scores of fatigue, insomnia pain, and economic status and loss of appetite in the non-depression group were lower than those in the depression group (P<0.05). The plotted forest plot showed that high PSQI score and HAMA score were risk factors for depression in patients with HCC. The multivariate linear regression analysis showed that the availability of depression had statistical significance on the quality of life of patients with HCC (P<0.05), and the quality of life of non-depression patients was 64.164 times higher than that of depression patients. Conclusion High PSQI and HAMA score are considered to be risk factors for depression in patients with HCC. The patients with HCC complicated with depression have poor quality of life. It is necessary to prevent the occurrence of depression symptoms in patients with HCC in clinical practices to improve the recovery and quality of life of patients.

Key words: liver neoplasms, depression, quality of life, risk factors

中图分类号:

R735.7

李亚, 邱世香, 陈超, 钟立明. 肝癌患者抑郁相关因素及其与生活质量的关系[J]. 临床荟萃, 2022, 37(6): 539-543.

Li Ya, Qiu Shixiang, Chen Chao, Zhong Liming. Depression-related factors and corresponding correlations with quality of life in patients with hepatocellular carcinoma[J]. Clinical Focus, 2022, 37(6): 539-543.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.06.011

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I6/539

图/表 6

参考文献 19

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组别	例数			年龄 (岁)				性别[例(%)]						饮酒[例(%)]					吸烟[例(%)]					能否承担费用[例(%)]
组别	例数			年龄 (岁)				男			女			有		无			有			无		能			否
抑郁组	23			57.112±11.527				18(78.2)			5(21.7)			8(34.8)		15(65.2)			7(30.4)			16(69.6)		11(47.8)			12(52.2)
非抑郁组	44			61.921±12.711				39(88.6)			5(11.4)			14(31.8)		30(68.2)			13(29.5)			1(70.5)		28(63.7)			16(36.3)
t/χ²值				-1.645				1.281						0.060					0.006					1.552
P值				0.105				0.258						0.806					0.940					0.213
组别		例数			疾病知情[例(%)]							数字疼痛量表评分 (分)					PSQI评分 (分)				HAMA评分 (分)					介入治疗次数
组别		例数			是				否			数字疼痛量表评分 (分)					PSQI评分 (分)				HAMA评分 (分)					介入治疗次数
抑郁组		23			14(60.9)				9(39.1)			4.432±1.623					13.091±4.246				17.784±6.432					1.610±3.094
非抑郁组		44			31(70.5)				13(29.5)			2.113±2.012					5.476±3.563				8.823±5.523					1.854±2.129
t/χ²值					0.629							4.774					7.765				5.980					-0.323
P值					0.428							0.000					0.000				0.000					0.749
组别			例数			肝癌分期[例(%)]														治疗方法[例(%)]
组别			例数			Ⅰa	Ⅰb			Ⅱa			Ⅱb		Ⅲa			Ⅲb		无			手术		介入			混合
抑郁组			23			0(0.0)	1(4.3)			0(0.0)			5(21.7)		13(56.5)			4(17.4)		11(47.8)			0(0.0)		11(47.8)			1(4.4)
非抑郁组			44			2(4.5)	9(20.5)			10(22.7)			19(43.2)		4(9.1)			0(0.0)		12(27.3)			1(2.3)		1(2.3)			2(4.4)
t/χ²值						31.881														3.210
P值						0.000														0.360

组别	例数			年龄 (岁)				性别[例(%)]						饮酒[例(%)]					吸烟[例(%)]					能否承担费用[例(%)]
组别	例数			年龄 (岁)				男			女			有		无			有			无		能			否
抑郁组	23			57.112±11.527				18(78.2)			5(21.7)			8(34.8)		15(65.2)			7(30.4)			16(69.6)		11(47.8)			12(52.2)
非抑郁组	44			61.921±12.711				39(88.6)			5(11.4)			14(31.8)		30(68.2)			13(29.5)			1(70.5)		28(63.7)			16(36.3)
t/χ²值				-1.645				1.281						0.060					0.006					1.552
P值				0.105				0.258						0.806					0.940					0.213
组别		例数			疾病知情[例(%)]							数字疼痛量表评分 (分)					PSQI评分 (分)				HAMA评分 (分)					介入治疗次数
组别		例数			是				否			数字疼痛量表评分 (分)					PSQI评分 (分)				HAMA评分 (分)					介入治疗次数
抑郁组		23			14(60.9)				9(39.1)			4.432±1.623					13.091±4.246				17.784±6.432					1.610±3.094
非抑郁组		44			31(70.5)				13(29.5)			2.113±2.012					5.476±3.563				8.823±5.523					1.854±2.129
t/χ²值					0.629							4.774					7.765				5.980					-0.323
P值					0.428							0.000					0.000				0.000					0.749
组别			例数			肝癌分期[例(%)]														治疗方法[例(%)]
组别			例数			Ⅰa	Ⅰb			Ⅱa			Ⅱb		Ⅲa			Ⅲb		无			手术		介入			混合
抑郁组			23			0(0.0)	1(4.3)			0(0.0)			5(21.7)		13(56.5)			4(17.4)		11(47.8)			0(0.0)		11(47.8)			1(4.4)
非抑郁组			44			2(4.5)	9(20.5)			10(22.7)			19(43.2)		4(9.1)			0(0.0)		12(27.3)			1(2.3)		1(2.3)			2(4.4)
t/χ²值						31.881														3.210
P值						0.000														0.360

组别		例数		躯体功能得分		角色功能得分		情绪功能得分		认知功能得分		社会功能得分		总体健康状况得分		疲倦得分
抑郁组		23		65.000±15.130		53.400±18.852		50.362±11.646		71.756±23.278		57.034±20.721		49.486±16.764		36.701±16.900
非抑郁组		44		73.541±19.442		69.321±21.250		76.123±21.443		84.874±16.374		66.821±18.491		72.354±12.220		21.720±22.600
t/χ²值				-1.834		-3.020		-5.350		-2.414		-1.974		-6.397		3.060
P值				0.073		0.000		0.000		0.020		0.052		0.000		0.000
组别	例数		疼痛得分		气促得分		失眠得分		恶心与呕吐得分		食欲丧失得分		便秘得分		腹泻得分		经济情况
抑郁组	23		42.752±21.800		5.780±16.340		57.253±21.803		2.900±6.462		34.784±15.821		8.700±23.000		5.800±19.200		34.780±15.822
非抑郁组	44		27.273±24.932		5.300±20.263		26.890±29.030		1.520±7.900		16.672±22.164		0.000±0.000		0.000±0.000		18.915±23.154
t/χ²值			2.521		0.110		4.810		0.721		3.900		1.821		1.443		2.942
P值			0.010		0.921		0.000		0.456		0.000		0.076		0.162		0.000

组别		例数		躯体功能得分		角色功能得分		情绪功能得分		认知功能得分		社会功能得分		总体健康状况得分		疲倦得分
抑郁组		23		65.000±15.130		53.400±18.852		50.362±11.646		71.756±23.278		57.034±20.721		49.486±16.764		36.701±16.900
非抑郁组		44		73.541±19.442		69.321±21.250		76.123±21.443		84.874±16.374		66.821±18.491		72.354±12.220		21.720±22.600
t/χ²值				-1.834		-3.020		-5.350		-2.414		-1.974		-6.397		3.060
P值				0.073		0.000		0.000		0.020		0.052		0.000		0.000
组别	例数		疼痛得分		气促得分		失眠得分		恶心与呕吐得分		食欲丧失得分		便秘得分		腹泻得分		经济情况
抑郁组	23		42.752±21.800		5.780±16.340		57.253±21.803		2.900±6.462		34.784±15.821		8.700±23.000		5.800±19.200		34.780±15.822
非抑郁组	44		27.273±24.932		5.300±20.263		26.890±29.030		1.520±7.900		16.672±22.164		0.000±0.000		0.000±0.000		18.915±23.154
t/χ²值			2.521		0.110		4.810		0.721		3.900		1.821		1.443		2.942
P值			0.010		0.921		0.000		0.456		0.000		0.076		0.162		0.000

变量	t/F/r值	P值
饮酒(是/否)	-0.499	0.620
吸烟(是/否)	0.416	0.679
病情知情情况(是/否)	0.030	0.976
承担治疗费用(是/否)	-0.243	0.809
治疗方法(无/手术治疗/介入治疗/混合治疗)	0.501	0.682
性别(男/女)	2.059	0.043
抑郁(有/无)	-6.387	0.000
肝癌分期(Ⅰa/Ⅰb/Ⅱa/Ⅱb/Ⅲa/Ⅲb)	0.086	0.444
介入治疗次数	-0.483	0.621
HAMA评分	-4.943	0.000
PSQI评分	-3.883	0.000
数字疼痛量表评分	-2.684	0.000
年龄	-0.882	0.382