【作者】 刘欣彤；

【导师】 周颖清；

【作者基本信息】 重庆医科大学 ， 护理学， 2008， 硕士

【摘要】 目的:探讨心理行为干预对卵巢癌患者情绪、T淋巴细胞亚群的动态变化规律及干预效果的影响因素,并进一步探讨心理行为干预的最佳时间。对象与方法:将符合要求的62名卵巢癌患者随机分为干预组和对照组,每组31名。所有患者均在干预前进行基线测评,包括汉密尔顿焦虑量表(HAMA)、抑郁量表(HAMD)、简易应对方式问卷、艾森克人格问卷(EPQ)和抽取静脉血用免疫组化碱性磷酸酶桥联酶标法(APAAP)测定T淋巴细胞亚群的功能。干预组心理行为干预持续三个月。心理行为干预第一个月后测定两组患者情绪和T淋巴细胞亚群(CD3+、CD4+、CD8+、CD4+/ CD8+)的数值。心理干预后第二个月、第三个月只测定两组患者的T淋巴细胞亚群的数值。结果:(1)干预组与对照组之间干预前均衡性比较没有显著性差异(P>0.05)(年龄、文化程度、职业、付费方式、肿瘤分期、焦虑、抑郁和T淋巴细胞亚群)。(2)心理行为干预后,两组焦虑、抑郁总分干预前后差值的比较有显著性差别(P<0.05),干预组的焦虑和抑郁明显减轻。(3)心理行为干预后焦虑、抑郁变化受人格因素的影响人格特质中的神经质与干预后抑郁有正相关性,未见神经质与干预后焦虑的相关性。内外向与干预后的焦虑、抑郁得分呈负相关。未见焦虑和抑郁与精神质相关。掩饰性与干预后焦虑有相关性,未见掩饰性与干预后抑郁的相关性。(4)心理行为干预一个月后CD3+(55.6±4.7/51.7±6.7,F=26.49)、CD4+(33.483±3.462/32.225±4.543 ,F=6.82)有显著性提高;干预2个月后各免疫参数CD3+(60.967±4.262/51.7±6.7,F=145.8)、CD4+(36.483±3.355/32.225±4.543,F=78.08)、CD8+(29.806±3.458/35.290±6.039,F=70.57)、CD4+/ CD8+(1.244±0.218/0.950±0.272,F=102.13)均有显著变化,且干预2个月与3个月相比各免疫参数变化不明显。干预组与对照组相比,不同时间点的各种免疫参数有显著性差异(P<0. 05),干预与时间点见明显的交互作用(P<0. 05),除CD8+(F=2.95,P>0. 05)外,两组患者各免疫参数存在显著性差异。(5)心理行为干预后T淋巴细胞亚群的变化受人格因素的影响神经质与CD8+正相关,但内外向、神经质和掩饰性与T淋巴细胞亚群(CD3+、CD4+、CD8+及CD4+/ CD8+比值)的相关性不明显。(6)影响心理行为干预效果的多元回归分析影响焦虑干预效果的因素有消极应对、掩饰性、和文化程度。影响抑郁干预效果的因素有消极应对、内外向和掩饰性。影响CD3+变化的因素有干预后抑郁。影响CD4+变化的因素有干预前焦虑、年龄、付费方式和干预前抑郁。影响CD8+变化的因素有积极应对方式、付费方式和掩饰性。影响CD4+/ CD8+变化的因素有积极应对、掩饰性和焦虑。结论:(1)心理行为干预能明显改善卵巢癌患者的焦虑和抑郁情绪。(2)心理行为干预可以提高卵巢癌患者T淋巴细胞亚群的免疫功能,且心理干预2个月后患者免疫功能维持在较高水平。(3)心理行为干预后影响患者焦虑、抑郁及T淋巴细胞亚群的因素各不相同。更多还原

【Abstract】 Objective:To examine the effects of psycho-behavioral intervention including educational intervention and progressive muscle relaxation on emotional disorder and the Changes of T lymphocyte subsets in Patients with Ovarian Cancer, and influencing factor, and further explore the best time. Subjects and Methods:62 inpatients were randomly assigned to either intervention group (n=31) or control group (n=31). All patients completed questionnaires including Hamilton Depression rating Scale(HAMD) ,Hamilton Anxiety rating Scale (HAMA), Simple Coping Style Questionnare, Eysenck Personality Questionnaire (EPQ) and immune parameter variables in both groups were measured with Alkaline Phosphatase Anti Alkaline Phosphatase ( APAAP ) technique at baseline assessment. The intervention group patients accepted psycho-behavioral intervention including educational intervention and progressive muscle relaxation for three months from the second chemotherapy. Emotion and coping style and T lymphocyte subsets were measured in all patients one month after psycho-behavioral intervention. T lymphocyte subsets were also measured during two and three months after psycho-behavioral intervention.Results:(1) There were no statistical significance between the intervention group and the control group in age, culture, occupation, pay style, tumor stage and T lymphocyte subsets at baseline assessment(p>0.05).(2) There were statistical significance between the intervention group and the control group in depression and anxiety (p<0.05), and the score in the intervention group decreased more.(3) Impact of personality on emotion. The neuroticism had positive correlation with depression after intervention, but the neuroticism had no correlation with anxiety after intervention. Extroversion and introversion had negative correlation with anxiety and depression after intervention.There were no correlation between anxiety, depression and psy- choticism.Cover up had positive correlation with anxiety after intervention, but the Cover up had no correlation with depression after intervention.(4) CD3+、CD4+ were increased significantly after psychological intervention for one month;All immune parameters were increased significantly after psychological intervention for two month,but no significant differences between two and three month. Difference between two groups were significant(P<0.05)in different time,interaction between intervention and time were also significant(P<0.05),except CD8+ ,all immune parameters were increased significantly.(5) Impact of personality on T lymphocyte subsets. The neuroticism had positive correlation with T lymphocyte subsets (CD8+ ), but the neuroticism , Extroversion and introversion, psychoticism and cover up had no correlation with T lymphocyte subsets.(6) Multiple stepwise regression of the influence factors of anxiety and depression after intervention. After intervention, factors of impacting anxiety were passive coping, cover up, and culture. Factors of impacting depression were passive coping, extroversion and introversion, and cover up. Factors of impacting CD3+ were depression. Factors of impacting CD4+ were age, fee sources and anxiety, depression before intervention. Factors of impacting CD8+ were active coping style, fee sources and cover up.Factors of impacting CD4+/ CD8+ were active coping style, cover up and anxiety.Conclusion:(1) Psycho-behavioral intervention can obviously improve the emotion in Patients with Ovarian Cancer.(2) Psycho-behavioral intervention can obviously improve the immunity of T lymphocyte subsets in Patients with Ovarian Cancer, which remained at a relatively high level after psychological intervention for two month.(3) The influence factors of anxiety, depression and T lymphocyte subsets in Patients with Ovarian Cancer were different after intervention.更多还原