结直肠癌术后化疗患者焦虑情绪、心理弹性与免疫应答的相关性分析

郑亚男; 张吉欣; 闫晨晨; 王一飞; 焦敏

doi:10.16766/j.cnki.issn.1674-4152.004301

结直肠癌术后化疗患者焦虑情绪、心理弹性与免疫应答的相关性分析

doi: 10.16766/j.cnki.issn.1674-4152.004301

河北北方学院附属第一医院胃肠外科，河北张家口 075000

基金项目:

河北省2024年度医学科学研究课题计划 20241845

详细信息

通讯作者:
焦敏，E-mail：15612302372@163.com

中图分类号: R735.35 R749.7
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出版历程
- 收稿日期: 2025-05-11
- 网络出版日期: 2026-03-13

The correlation among anxiety, mental resilience and immune response in patients with colorectal cancer after chemotherapy

Department of Gastrointestinal Surgery, the First Affiliated Hospital of Hebei North University, Zhangjiakou, Hebei 075000, China

摘要

摘要: 目的对结直肠癌术后化疗患者焦虑情绪、心理弹性与免疫应答的相关性进行研究，以期为临床治疗提供参考。方法选择2021年5月—2024年1月河北北方学院附属第一医院收治的140例结直肠癌术后化疗患者，分别采用Zung焦虑自评量表、中文版Connor-Davidson心理弹性量表评估焦虑情绪、心理弹性，酶联免疫吸附法检测免疫应答水平，Pearson相关性分析分析相关性，logistic回归分析研究免疫应答能力影响因素。结果单因素重复测量方差分析结果显示，患者SAS、坚韧、自强、乐观评分在化疗前、化疗1个疗程后和化疗3个疗程后差异均存在统计学意义(P＜0.05)，IL-2、IL-4、IL-10和IL-17水平在化疗前、化疗1个疗程后和化疗3个疗程后差异均存在统计学意义(P＜0.05)；患者IL-2、IL-17水平与SAS评分均呈正相关关系(r=0.767、0.703)，与心理弹性各维度评分均呈负相关关系(r=-0.674、-0.714、-0.674、-0.615、-0.643、-0.523)；IL-4、IL-10水平与SAS评分均呈负相关关系(r=-0.664、-0.736)，心理弹性各维度评分呈正相关关系(r=0.502、0.534、0.481、0.601、0.622、0.515，P＜0.05)；logistic回归分析结果显示，TNM分期、SAS评分、心理弹性评分、文化程度和人均月收入均是结直肠癌术后化疗患者免疫应答能力的独立影响因素(OR 95% CI分别为1.130~15.990、1.029~11.557、1.327~5.841、1.680~8.125、1.626~12.630，P＜0.05)。结论结直肠癌术后化疗患者化疗后焦虑情绪、心理弹性差等可能与免疫应答水平的异常具有一定的相关性。
- 结直肠癌 /
- 术后化疗 /
- 焦虑情绪 /
- 心理弹性 /
- 免疫应答 /
- 相关性
Abstract: Objective To study the correlation among anxiety, mental resilience, and immune response in patients with colorectal cancer after chemotherapy, in order to provide a reference for clinical treatment. Methods A total of 140 patients with chemotherapy after colorectal cancer surgery, admitted to the First Affiliated Hospital of Hebei North University from May 2021 to January 2024, were chosen. The anxiety and mental resilience were evaluated by the Zung anxiety self-rating scale (SAS) and the Chinese version of the Connor-Davidson resilience scale (CD-RISC), and an enzyme-linked immunosorbent assay was used to detect immune response levels and the correlation was analyzed by Pearson correlation. Logistic regression was used to analyze the influencing factors of immune response ability. Results The results of single-factor repeated measurement showed that there were significant differences in SAS, tenacity, self-reliance and optimism score before chemotherapy, after 1 course and 3 courses of chemotherapy (P < 0.05), the levels of interleukin-2 (IL-2), IL-4, IL-10 and IL-17 also had significant differences (P < 0.05); The levels of IL-2 and IL-17 were positively correlated with SAS scores, and negatively correlated with scores of various dimensions of mental resilience; IL-4 and IL-10 levels were negatively correlated with SAS scores (r=0.767 and 0.703), and negatively correlated with scores of various dimensions of mental resilience (r=-0.674, -0.714, -0.674, -0.615, -0.643, -0.523); IL-4 and IL-10 levels were negatively correlated with SAS scores (r=-0.664, -0.736), and positively correlated with scores of mental resilience (r=0.502, 0.534, 0.481, 0.601, 0.622, 0.515, P < 0.05). Logistic regression analysis showed that TNM stage, SAS score, mental resilience score, educational level, and per capita monthly income were independent risk factors affecting the immune response ability of patients with colorectal cancer after chemotherapy (OR 95% CI: 1.130-15.990, 1.029-11.557, 1.327-5.841, 1.680-8.125, 1.626-12.630, P < 0.05). Conclusion The anxiety and psychological resilience of patients with postoperative chemotherapy for colorectal cancer may be related to the abnormal level of immune response.
- Colorectal cancer /
- Postoperative chemotherapy /
- Anxiety /
- Mental resilience /
- Immune response /
- Correlation

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表 1 140例结直肠癌患者化疗前后的焦虑情绪和心理弹性评分比较(x±s，分)

Table 1. Comparison of anxiety levels and psychological resilience scores before and after chemotherapy of 140 patients with colorectal cancer (x±s, points)

时间	SAS评分	心理弹性
时间	SAS评分	坚韧	自强	乐观
化疗前	40.19±12.28	36.32±4.56	22.18±2.57	11.28±2.06
化疗1个疗程后	51.28±10.38^a	30.27±5.67^a	19.03±3.52^a	9.24±2.31^a
化疗3个疗程后	48.08±8.24^ab	32.57±4.13^ab	20.24±2.19^ab	10.48±1.84^ab
F值	41.918	55.955	44.576	34.226
P值	＜0.001	＜0.001	＜0.001	＜0.001
注：与化疗前比较，^aP＜0.05；与化疗1个疗程后比较，^bP＜0.05。

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表 2 140例结直肠癌患者化疗前后免疫应答水平比较(x±s，pg/mL)

Table 2. Comparison of immune response level before and after chemotherapy of 140 patients with colorectal cancer (x±s, pg/mL)

时间	IL-2	IL-4	IL-10	IL-17
化疗前	2.65±0.46	1.41±0.32	1.48±0.39	0.88±0.15
化疗1个疗程后	3.12±0.53^a	1.18±0.27^a	1.16±0.34^a	1.04±0.27^a
化疗3个疗程后	2.98±0.64^ab	1.33±0.34^ab	1.29±0.41^ab	0.92±0.18^ab
F值	27.112	19.684	24.961	22.786
P值	＜0.001	＜0.001	＜0.001	＜0.001
注：与化疗前比较，^aP＜0.05；与化疗1个疗程后比较，^bP＜0.05。

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表 3 焦虑情绪、心理弹性评分和免疫应答的相关性(r值)

Table 3. Correlation of anxiety, psychological resilience score and immune response (r value)

项目	维度	IL-2	IL-4	IL-10	IL-17
SAS评分		0.767^a	-0.664^a	-0.736^a	0.703^a
心理弹性	坚韧	-0.674^a	0.502^a	0.601^a	-0.615^a
	自强	-0.714^a	0.534^a	0.622^a	-0.643^a
	乐观	-0.674^a	0.481^a	0.515^a	-0.523^a
注：^aP＜0.05。

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表 4 结直肠癌患者免疫应答能力影响因素的单因素分析

Table 4. Univariate analysis of factors affecting the immune response ability of patients with colorectal cancer

项目	免疫应答良好组 (n=91)	免疫应答不佳组 (n=49)	统计量	P值
性别[例(%)]			0.038^a	0.845
男性	48(52.75)	25(51.02)
女性	43(47.25)	24(48.98)
年龄[例(%)]			0.107^a	0.743
≥60岁	55(60.44)	31(63.27)
＜60岁	36(39.56)	18(36.73)
TNM分期[例(%)]			7.831^a	0.020
Ⅰ期	7(7.69)	3(6.12)
Ⅱ期	43(47.25)	12(24.49)
Ⅲ期	41(45.05)	34(69.39)
SAS评分(x±s，分)	48.47±8.35	51.93±10.23	2.158^b	0.033
心理弹性(x±s，分)
坚韧	32.58±5.65	29.27±4.28	3.582^b	0.001
自强	20.23±3.35	18.54±2.45	3.110^b	0.002
乐观	10.30±2.32	9.04±2.04	3.194^b	0.002
总分	63.11±4.42	56.85±3.16	8.774^b	＜0.001
文化程度[例(%)]			7.692^a	0.006
中学及以下	30(32.97)	28(57.14)
中学以上	61(67.03)	21(42.86)
人均月收入[例(%)]			9.176^a	0.008
≤4 000元	9(9.89)	14(28.57)
4 000~8 000元	43(47.25)	23(46.94)
＞8 000元	39(42.86)	12(24.49)
注：^a为χ²值，^b为t值。

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表 5 结直肠癌患者免疫应答能力影响因素的logistic回归分析

Table 5. Logistic regression analysis of factors affecting the immune response ability of patients with colorectal cancer

变量	B	SE	Waldχ²	P值	OR值	95% CI
TNM分期	1.447	0.676	4.582	0.033	4.250	1.130~15.990
SAS评分	1.238	0.617	4.026	0.045	3.449	1.029~11.557
心理弹性	1.024	0.378	7.339	0.007	2.784	1.327~5.841
文化程度	1.307	0.402	10.571	0.001	3.695	1.680~8.125
人均月收入	1.511	0.523	8.347	0.004	4.531	1.626~12.630

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