鼻咽癌调强放疗患者居家康复期症状特征的潜在类别分析

朱云霞; 杨璨; 汪和美; 陈锃丽; 费珍珍

doi:10.16766/j.cnki.issn.1674-4152.003526

鼻咽癌调强放疗患者居家康复期症状特征的潜在类别分析

doi: 10.16766/j.cnki.issn.1674-4152.003526

浙江省肿瘤医院头颈肿瘤放疗科中国科学院基础医学与肿瘤研究所，浙江杭州 310022

基金项目:

浙江省医药卫生科技计划面上项目 2020KY467

浙江省医药卫生科技计划临床应用研究项目 2022KY695

详细信息

通讯作者:
汪和美，E-mail: hlky2009@126.com

中图分类号: R739.6 R730.55
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出版历程
- 收稿日期: 2023-11-19
- 网络出版日期: 2024-07-20

Latent class analysis of symptom characteristics of nasopharyngeal carcinoma patients receiving intensity modulated radiation therapy during rehabilitation periodone

Department of Head and Neck Oncology Radiotherapy, Zhejiang Cancer Hospital, Hangzhou Institute of Medicine (HIM), Chinese Academy of Sciences, Hangzhou, Zhejiang 310022, China

摘要

摘要: 目的通过对鼻咽癌患者调强放疗结束后1年症状的随访调查，了解鼻咽癌患者放疗结束后的症状困扰现状以及症状特征的潜在类别，并探讨不同类别患者之间的症状特征差异，为临床护理人员制定针对性的延续性症状管理提供策略。方法采用便利抽样法，选择2020年1月—2021年12月在浙江省肿瘤医院行调强放疗且放疗结束满1年的鼻咽癌患者为研究对象，应用一般资料调查表、头颈部癌症患者特异性生存质量量表QLQ.H&N35进行随访调查，对患者的症状特征进行潜在类别分析，并比较不同类型患者的一般特征。结果共纳入患者156例，患者放疗结束后1年发生率较高的症状有性欲减退(52.6%)、口干(50.6%)、牙齿问题(39.7%)，较严重的症状为口干[2.0(1.0，2.0)分]、性欲减退[1.5(1.0，2.0)分]；鼻咽癌患者症状特征可分为3个潜在类别，分别命名为低症状反应组(77.56%)、高躯体症状反应组(12.18%)、情绪心理困扰组(10.26%)；单因素分析显示三类患者在文化程度、BMI、放疗方式上差异均有统计学意义(P < 0.05)。结论鼻咽癌调强放疗患者居家康复期症状特征可分为3个潜在类别，医护工作者应识别不同患者的潜在类别特征，为患者提供延续性的症状随访管理及心理疏导干预，以减轻患者的身心症状反应，改善患者居家康复期间的生活质量，促进康复。
- 鼻咽癌 /
- 调强放疗 /
- 症状特征 /
- 潜在类别分析
Abstract: Objective To understand the current status of symptom distress and potential categories of symptom characteristics in nasopharyngeal carcinoma patients after radiation therapy by a one-year follow-up of symptoms in nasopharyngeal carcinoma patients after intensity-modulated radiation therapy, and to explore the differences in symptom characteristics among different types of patients to provide strategies for clinical nurses to develop targeted and sustained symptom management. Methods Nasopharyngeal carcinoma patients undergoing intensity-modulated radiation therapy and completing radiation therapy after one year were selected in Zhejiang Cancer Hospital from January 2020 to December 2022. General information questionnaire and QLQ. H&N35 were utilized as the investigating tools. Latent class analysis (LCA)was used to explore the latent classes of the symptom characteristics of nasopharyngeal carcinoma patients, and the general characteristics of different types of patients were analyzed. Results A total of 156 patients were selected. The symptoms with a high incidence rate were hyposexuality (52.6%), dry mouth (50.6%), and dental problems (39.7%) one year after radiotherapy in nasopharyngeal carcinoma patients. Among them, the severity of dry mouth [2.00 (1.0, 2.0) points] and hyposexuality [1.5 (1.0, 2.0) points] were higher. The symptom characteristics of nasopharyngeal carcinoma patients could be divided into three latent classes, which were named low symptom response group (77.56%), high physical symptoms response group (12.18%), and emotional psychological distress group (10.26%). One-way ANOVA showed that there were significant differences in education level, BMI, and radiation therapy methods among the three types. Conclusion The symptoms of nasopharyngeal carcinoma patients receiving intensity-modulated radiation therapy during home rehabilitation include three latent classes. Medical workers should identify the latent class to provide continuous symptom follow-up management and psychological counseling intervention for patients, reduce the physical and mental symptoms of patients and psychological counseling interventions, improve the quality of life of patients during home rehabilitation, and promote rehabilitation.
- Nasopharyngeal carcinoma /
- Intensity modulated radiation therapy /
- Symptom characteristics /
- Latent class analysis

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图 1 鼻咽癌患者调强放疗结束后1年3个潜在类别特征分布

Figure 1. One-year distribution of three potential category characteristics in nasopharyngeal carcinoma patients post-intensity-modulated radiation therapy

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表 1 鼻咽癌患者调强放疗结束后1年症状发生率及严重程度

Table 1. Incidence and severity of symptoms one year after intensity-modulated radiotherapy in nasopharyngeal carcinoma patients

鼻咽癌特异性症状	例(%)	严重程度得分[M(P₂₅, P₇₅)，分]
疼痛	12(7.7)	1.0(1.0, 1.0)
吞咽困难	17(10.9)	1.0(1.0, 1.0)
牙齿问题	62(39.7)	1.0(1.0, 2.0)
张口困难	15(9.6)	1.0(1.0, 1.0)
口干	79(50.6)	2.0(1.0, 2.0)
唾液黏稠	32(20.5)	1.0(1.0, 1.0)
感觉问题	30(19.2)	1.0(1.0, 1.0)
咳嗽	22(14.1)	1.0(1.0, 1.0)
语言问题	27(17.3)	1.0(1.0, 1.0)
病态感	27(17.3)	1.0(1.0, 1.0)
社交困难	32(20.5)	1.0(1.0, 1.0)
进食困难	42(26.9)	1.0(1.0, 1.3)
性欲减退	82(52.6)	1.5(1.0, 2.0)
体重减轻	46(29.5)	1.0(1.0, 1.0)

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表 2 鼻咽癌患者调强放疗结束后1年症状特征的潜在类别模型拟合结果(n=156)

Table 2. Latent class model analysis of symptom characteristics in nasopharyngeal carcinoma patients one year after intensity-modulated radiation therapy (n=156)

模型	k	AIC	BIC	aBIC	Entropy	P值		类别比例(%)
模型	k	AIC	BIC	aBIC	Entropy	LMR	BLRT	类别比例(%)
1	20	1 748.463	1 809.460	1 746.153	1		NA	NA
2	31	1 379.392	1 473.937	1 375.813	0.986	＜0.001	0.01	14.10/85.90
3	42	1 249.963	1 378.057	1 245.113	0.964	＜0.001	0.01	10.26/12.18/77.56
4	53	1 271.971	1 433.613	1 265.851	0.629	1	1	10.25/76.92/12.82/0
5	64	1 159.272	1 354.462	1 151.883	0.701	＜0.001	0.01	10.26/73.08/7.69/8.97/0
注：AIC为艾凯克信息准则，BIC为贝叶斯信息标准，aBIC为样本校正的贝叶斯信息标准，Entropy为信息熵，LMR为似然比检验，BLRT为Bootstrap的似然比检验。

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表 3 鼻咽癌患者调强放疗结束后1年症状特征的潜在类别归属概率矩阵(%)

Table 3. Probability matrix of potential symptom categories one year after intensity-modulated radiotherapy in nasopharyngeal carcinoma patients (%)

潜在类别	情绪心理困扰组	高躯体症状反应组	低症状反应组
情绪心理困扰	99.993	0.001	0.006
高躯体症状反应组	0.015	98.268	1.717
低症状反应组	0.000	1.628	98.372

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表 4 156例鼻咽癌患者放疗结束1年一般资料及潜在类别单因素分析[例(%)]

Table 4. Univariate analysis of general data and potential categories in 156 nasopharyngeal carcinoma patients one year post-radiotherapy [cases (%)]

项目	C1情绪心理困扰组(n=16)	C2高躯体症状反应组(n=19)	C3低症状反应组(n=121)	χ²值	P值
年龄(岁)				0.288	0.866
＜60	12(75.0)	14(73.7)	95(78.5)
≥60	4 (25.0)	5(26.3)	26(21.5)
BMI				28.170	＜0.001
＜18.5	4(25.0)	0	1(0.8)
≥24.0	5(31.3)	6(31.6)	51(42.1)
18.5~＜24.0	7(43.8)	13(68.4)	69(57.0)
疾病分期				5.367	0.252
Ⅱ	0	2(10.5)	11(9.1)
Ⅲ	7(43.8)	12(63.2)	73(60.3)
Ⅳ	9(56.3)	5(26.3)	37(30.6)
性别				4.873	0.087
女性	7(43.8)	2(10.5)	35(28.9)
男性	9(56.3)	17(89.5)	86(71.1)
文化程度				14.899	0.021
小学及以下	8(50.0)	4(21.1)	45(37.2)
初中	3(18.8)	2(10.5)	37(30.6)
高中	1(6.3)	3(15.8)	18(14.9)
大专/本科及以上	4(25.0)	10(52.6)	21(17.4)
放疗方式				10.903	0.004
TOM0	8(50.0)	5(26.3)	79(65.3)
IMRT	8(50.0)	14(73.7)	42(34.7)
注：TOMO为螺旋断层放疗(tomotherapy)。

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