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Article(id=1322168493932396819, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168481081049284, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.09.008, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1765382400000, receivedDateStr=2025-12-11, revisedDate=1773849600000, revisedDateStr=2026-03-19, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159133656, onlineDateStr=2026-10-28, pubDate=1778342400000, pubDateStr=2026-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159133656, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159133656, creator=13701087609, updateTime=1793159133656, updator=13701087609, issue=Issue{id=1322168481081049284, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='9', pageStart='1425', pageEnd='1616', issueExtLink='null', onlineDate='null', pubDate='1778342400000', pubDateStr='2026-05-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793159130592, creator='13701087609', updateTime=1793159130592, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext=null, issueFiles=null, downloadFileDto=null}, startPage=1488, endPage=1494, ext={EN=ArticleExt(id=1322168494158889236, articleId=1322168493932396819, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Latent profile analysis and influencing factors of cancer-related cognitive impairment in lung cancer patients, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the latent profiles of cognitive function in lung cancer patients and their influencing factors.

Methods

A total of 296 lung cancer patients who visited the oncology department of a tertiary grade A hospital in Chongqing from January to August 2025 were selected as the survey subjects.General information questionnaire,Functional Assessment of Cancer Therapy-Cognitive Function Scale,Exercise Adherence Scale,and Self-Rating Anxiety Scale were used for investigation.Latent profile analysis was employed to explore the latent profiles of cancer-related cognitive impairment,while univariate analysis and multinomial Logistic regression analysis were used to investigate the influencing factors of latent profiles in cancer-related cognitive impairment patients.

Results

Cancer-related cognitive impairment patients could be classified into three latent profiles:high cognitive function group(67.2%),moderate cognitive function group(22.6%),and low cognitive function group(10.1%).Multinomial Logistic regression results showed that educational level,tumor stage,age,exercise adherence,and anxiety were influencing factors of latent profiles of cognitive function in lung cancer patients(all P<0.05).

Conclusions

Cancer-related cognitive function in lung cancer patients exhibits group heterogeneity.It suggests that healthcare professionals should develop more targeted intervention measures based on the influencing factors of different categories of lung cancer patients' cognitive function levels.

, authors=Xiaoju ZHU1, 2, Sixiong LUO1, 3, Haiwei FU1, Wei GUAN2, Zonghua WANG1, authorsList=Xiaoju ZHU, Sixiong LUO, Haiwei FU, Wei GUAN, Zonghua WANG, authorCompany=null, correspAuthors=Zonghua WANG, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322168494800617751, articleId=1322168493932396819, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=肺癌病人癌症相关认知障碍潜在剖面分析及影响因素, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

探究肺癌病人认知功能的潜在剖面及影响因素。

方法

选取2025年1月—8月在重庆市某三级甲等医院肿瘤科就诊的296例肺癌病人为调查对象，采用一般资料调查表、癌症治疗功能评估-认知功能量表、运动依从性量表、焦虑自评量表对其进行调查，运用潜在剖面分析探究癌症相关认知障碍的潜在剖面，采用单因素分析、无序多分类Logistic回归分析探究癌症认知障碍病人潜在剖面的影响因素。

结果

癌症相关认知障碍病人可分为3个潜在剖面：高认知功能组（67.2%）、中等认知功能组（22.6%）、低认知功能组（10.1%）。无序多分类 Logistic 回归结果显示，文化程度、肿瘤分期、年龄、运动依从性、焦虑是肺癌病人认知功能潜在剖面的影响因素（均P<0.05）。

结论

肺癌病人癌症相关认知障碍存在群体异质性，提示医护人员可根据不同类别肺癌病人认知功能水平的影响因素，制定更具针对性的干预措施。

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朱晓菊，硕士研究生在读

, correspAuthorsNote=
王宗华，E-mail：
WANG Zonghua, E-mail:
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figs=[ArticleFig(id=1322531281775215254, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=EN, label=Figure 1, caption=Distribution of latent profiles in four cognitive domains of lung cancer patients, figureFileSmall=WyO4dN9aM5+7Bpc44+O3LQ==, figureFileBig=HeGGBanu3+I0mkvlhDIJWg==, tableContent=null), ArticleFig(id=1322531281846518423, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=CN, label=图1, caption=肺癌病人认知功能4个维度潜在剖面的特征分布, figureFileSmall=WyO4dN9aM5+7Bpc44+O3LQ==, figureFileBig=HeGGBanu3+I0mkvlhDIJWg==, tableContent=null), ArticleFig(id=1322531281972347544, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=EN, label=Table 1, caption=

Cancer-related cognitive impairment scores in lung cancer patients（x±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目得分条目均分
总分117.23±10.983.16±0.30
CogPCI63.50±6.673.18±0.33
CogPCA26.11±4.572.90±0.51
CogQOL13.69±2.583.42±0.65
CogOTH13.93±2.423.48±0.61
), ArticleFig(id=1322531282064622233, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=CN, label=表1, caption=

肺癌病人癌症相关认知障碍得分（x±s）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目得分条目均分
总分117.23±10.983.16±0.30
CogPCI63.50±6.673.18±0.33
CogPCA26.11±4.572.90±0.51
CogQOL13.69±2.583.42±0.65
CogOTH13.93±2.423.48±0.61
), ArticleFig(id=1322531282253365914, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=EN, label=Table 2, caption=

Results of latent profile analysis on cognitive function in lung cancer patients

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类别AICBICaBICPEntropy类别概率
LMRTBLRT
11 763.1481 792.6711 767.3011.000
21 565.5221 613.4971 572.2700.006<0.0010.8720.287/0.713
31 518.2511 584.6771 527.5940.038<0.0010.8910.101/0.226/0.672
41 476.0571 560.9361 487.9950.011<0.0010.9340.098/0.010/0.632/ 0.260
51 435.3431 538.6731 449.8760.453<0.0010.9040.159/0.199/0.101/0.010/0.530
), ArticleFig(id=1322531282362417819, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=CN, label=表2, caption=

肺癌病人认知功能的潜在剖面分析结果

, figureFileSmall=null, figureFileBig=null, tableContent=
类别AICBICaBICPEntropy类别概率
LMRTBLRT
11 763.1481 792.6711 767.3011.000
21 565.5221 613.4971 572.2700.006<0.0010.8720.287/0.713
31 518.2511 584.6771 527.5940.038<0.0010.8910.101/0.226/0.672
41 476.0571 560.9361 487.9950.011<0.0010.9340.098/0.010/0.632/ 0.260
51 435.3431 538.6731 449.8760.453<0.0010.9040.159/0.199/0.101/0.010/0.530
), ArticleFig(id=1322531282437915292, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=EN, label=Table 3, caption=

Univariate analysis of influencing factors for latent profiles of cancer-related cognitive function in lung cancer patients

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类低认知功能组
(n=30)		中等认知功能组
(n=67)		高认知功能组
(n=199)		统计值P
性别[例（%）]男21(70.0)53(79.1)146(73.4)χ2=1.1920.551
女9(30.0)14(20.9)53(26.6)
文化程度[例（%）]小学及以下17(56.7)24(35.8)53(26.6)χ2=31.656<0.001
初中9(30.0)15(22.4)63(31.7)
高中3(10.0)25(37.3)39(19.6)
专科及以上1(3.3)3(4.5)44(22.1)
工作状况[例（%）]企事业人员2(6.7)6(9.0)16(8.0)χ2=7.6640.264
离退休人员4(13.3)13(19.4)56(28.1)
自由职业14(46.7)21(31.3)73(36.7)
其他10(33.3)27(40.3)54(27.1)
居住地[例（%）]城镇9(30.0)30(44.8)94(47.2)χ2=3.1310.209
农村21(70.0)37(55.2)105(52.8)
婚姻状况[例（%）]已婚29(96.7)58(86.6)182(91.5)χ2=2.7950.247
离异/丧偶1(3.3)9(13.4)17( 8.5)
人均月收入[例（%）]<3 000元23(76.7)38(56.7)116(58.3)
3 000~5 000元6(20.0)20(29.9)57(28.6)χ2=4.5500.337
>5 000元1(3.3)9(13.4)26(13.1)
医保类型[例（%）]职工医保4(13.3)18(26.9)68(34.2)
居民医保26(86.7)47(70.1)127(63.8)χ2=7.0910.131
其他0(0.0)2(3.0)4(2.0)
有无转移[例（%）]有16(53.3)34(50.7)97(48.7)χ2=0.2600.878
无14(46.7)33(49.3)102(51.3)
肿瘤分期[例（%）]Ⅰ/Ⅱ期5(16.7)17(25.4)76(38.2)
Ⅲ期10(33.3)28(41.8)68(34.2)χ2=10.3630.035
Ⅳ期15(50.0)22(32.8)55(27.6)
治疗周期[例（%）]1期/2期9(30.0)31(46.3)97(48.7)
3期/4期16(53.3)20(29.9)66(33.2)χ2=6.5790.160
≥5期5(16.7)16(23.9)36(18.1)
治疗方式[例（%）]化疗17(56.7)33(49.3)91(45.7)
免疫2(6.7)2(3.0)6(3.0)χ2=2.9300.570
化疗联合免疫11(36.7)32(47.8)102(51.3)
病理类型[例（%）]非小细胞肺癌20(66.7)60(89.6)164(82.4)χ2=7.4950.024
小细胞肺癌10(33.3)7(10.4)35(17.6)
合并症[例（%）]无18(60.0)43(64.2)128(64.3)
1个8(26.7)17(25.4)60(30.2)χ2=3.7210.445
≥2个4(13.3)7(10.4)11(5.5)
年龄（岁）66.00(62.00,69.00)62.00(59.50,66.00)61.00(55.50,66.00)H=14.698<0.001
运动依从性（分）36.00(34.00,36.75)36.00(36.00,38.00)38.00(36.00,39.00)H=15.654<0.001
焦虑（分）58.00(56.00,60.00)57.00(54.00,60.00)54.00(52.00,58.00)H=20.865<0.001
), ArticleFig(id=1322531282521801373, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=CN, label=表3, caption=

肺癌病人癌症相关认知障碍潜在剖面影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类低认知功能组
(n=30)		中等认知功能组
(n=67)		高认知功能组
(n=199)		统计值P
性别[例（%）]男21(70.0)53(79.1)146(73.4)χ2=1.1920.551
女9(30.0)14(20.9)53(26.6)
文化程度[例（%）]小学及以下17(56.7)24(35.8)53(26.6)χ2=31.656<0.001
初中9(30.0)15(22.4)63(31.7)
高中3(10.0)25(37.3)39(19.6)
专科及以上1(3.3)3(4.5)44(22.1)
工作状况[例（%）]企事业人员2(6.7)6(9.0)16(8.0)χ2=7.6640.264
离退休人员4(13.3)13(19.4)56(28.1)
自由职业14(46.7)21(31.3)73(36.7)
其他10(33.3)27(40.3)54(27.1)
居住地[例（%）]城镇9(30.0)30(44.8)94(47.2)χ2=3.1310.209
农村21(70.0)37(55.2)105(52.8)
婚姻状况[例（%）]已婚29(96.7)58(86.6)182(91.5)χ2=2.7950.247
离异/丧偶1(3.3)9(13.4)17( 8.5)
人均月收入[例（%）]<3 000元23(76.7)38(56.7)116(58.3)
3 000~5 000元6(20.0)20(29.9)57(28.6)χ2=4.5500.337
>5 000元1(3.3)9(13.4)26(13.1)
医保类型[例（%）]职工医保4(13.3)18(26.9)68(34.2)
居民医保26(86.7)47(70.1)127(63.8)χ2=7.0910.131
其他0(0.0)2(3.0)4(2.0)
有无转移[例（%）]有16(53.3)34(50.7)97(48.7)χ2=0.2600.878
无14(46.7)33(49.3)102(51.3)
肿瘤分期[例（%）]Ⅰ/Ⅱ期5(16.7)17(25.4)76(38.2)
Ⅲ期10(33.3)28(41.8)68(34.2)χ2=10.3630.035
Ⅳ期15(50.0)22(32.8)55(27.6)
治疗周期[例（%）]1期/2期9(30.0)31(46.3)97(48.7)
3期/4期16(53.3)20(29.9)66(33.2)χ2=6.5790.160
≥5期5(16.7)16(23.9)36(18.1)
治疗方式[例（%）]化疗17(56.7)33(49.3)91(45.7)
免疫2(6.7)2(3.0)6(3.0)χ2=2.9300.570
化疗联合免疫11(36.7)32(47.8)102(51.3)
病理类型[例（%）]非小细胞肺癌20(66.7)60(89.6)164(82.4)χ2=7.4950.024
小细胞肺癌10(33.3)7(10.4)35(17.6)
合并症[例（%）]无18(60.0)43(64.2)128(64.3)
1个8(26.7)17(25.4)60(30.2)χ2=3.7210.445
≥2个4(13.3)7(10.4)11(5.5)
年龄（岁）66.00(62.00,69.00)62.00(59.50,66.00)61.00(55.50,66.00)H=14.698<0.001
运动依从性（分）36.00(34.00,36.75)36.00(36.00,38.00)38.00(36.00,39.00)H=15.654<0.001
焦虑（分）58.00(56.00,60.00)57.00(54.00,60.00)54.00(52.00,58.00)H=20.865<0.001
), ArticleFig(id=1322531282614076062, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=EN, label=Table 4, caption=

Multinomial Logistic regression of cognitive function latent profiles in lung cancer patients

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项目中等认知功能组高认知功能组
回归系数POR值95%CI回归系数POR值95%CI
文化程度（以小学及以下为参照）
初中0.0070.9911.007[0.313,3.243]0.7210.1822.056[0.713,5.929]
高中1.8640.0176.073[1.384,26.654]1.4890.0434.434[1.047,18.786]
专科及以上0.4870.6951.627[0.143,18.553]2.2660.0399.638[1.123,82.745]
年龄-0.0730.0620.929[0.860,1.004]-0.0780.0340.925[0.861,0.994]
肿瘤分期（以Ⅰ/Ⅱ期为参照）
Ⅲ期0.2240.7421.251[0.330,4.740]-0.0730.5570.689[0.198,2.392]
Ⅳ期-0.7160.2870.489[0.131,1.825]-1.4390.0220.237[0.069,0.809]
病理类型（以非小细胞肺癌为参照）
小细胞肺癌-1.1640.0630.312[0.091,1.067]-0.3510.5110.704[0.247,2.005]
运动依从性0.2730.0051.314[1.084,1.593]0.2990.0011.348[1.124,1.617]
焦虑-0.0530.4190.949[0.834,1.078]-0.1480.0150.863[0.766,0.972]
), ArticleFig(id=1322531284283409055, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322168493932396819, language=CN, label=表4, caption=

肺癌病人认知功能潜在剖面的无序多分类Logistic回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目中等认知功能组高认知功能组
回归系数POR值95%CI回归系数POR值95%CI
文化程度（以小学及以下为参照）
初中0.0070.9911.007[0.313,3.243]0.7210.1822.056[0.713,5.929]
高中1.8640.0176.073[1.384,26.654]1.4890.0434.434[1.047,18.786]
专科及以上0.4870.6951.627[0.143,18.553]2.2660.0399.638[1.123,82.745]
年龄-0.0730.0620.929[0.860,1.004]-0.0780.0340.925[0.861,0.994]
肿瘤分期（以Ⅰ/Ⅱ期为参照）
Ⅲ期0.2240.7421.251[0.330,4.740]-0.0730.5570.689[0.198,2.392]
Ⅳ期-0.7160.2870.489[0.131,1.825]-1.4390.0220.237[0.069,0.809]
病理类型（以非小细胞肺癌为参照）
小细胞肺癌-1.1640.0630.312[0.091,1.067]-0.3510.5110.704[0.247,2.005]
运动依从性0.2730.0051.314[1.084,1.593]0.2990.0011.348[1.124,1.617]
焦虑-0.0530.4190.949[0.834,1.078]-0.1480.0150.863[0.766,0.972]
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肺癌病人癌症相关认知障碍潜在剖面分析及影响因素
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朱晓菊 1, 2 , 罗思熊 1, 3 , 付海炜 1 , 关伟 2 , 王宗华 1, *, *
护理研究 | 科研论著 2026,40(9): 1488-1494
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护理研究 |科研论著 2026 , 40 (9) : 1488 -1494
肺癌病人癌症相关认知障碍潜在剖面分析及影响因素
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朱晓菊1, 2, 罗思熊1, 3, 付海炜1, 关伟2, 王宗华1, *, *
作者信息
  • 1中国人民解放军陆军军医大学，重庆 400038
  • 2中国人民解放军陆军军医大学大坪医院
  • 3重庆市护士学校
通讯作者:
王宗华，E-mail：
WANG Zonghua, E-mail:
作者简介:

朱晓菊，硕士研究生在读

Latent profile analysis and influencing factors of cancer-related cognitive impairment in lung cancer patients
Xiaoju ZHU1, 2, Sixiong LUO1, 3, Haiwei FU1, Wei GUAN2, Zonghua WANG1
Affiliations
  • 1Army Medical University of Chinese PLA, Chongqing 400038 China
  • 2Daping Hospital, Army Medical University of Chinese PLA
  • 3Chongqing Nursing School
出版时间: 2026-05-10 doi: 10.12102/j.issn.1009-6493.2026.09.008
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摘要
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目的

探究肺癌病人认知功能的潜在剖面及影响因素。

方法

选取2025年1月—8月在重庆市某三级甲等医院肿瘤科就诊的296例肺癌病人为调查对象，采用一般资料调查表、癌症治疗功能评估-认知功能量表、运动依从性量表、焦虑自评量表对其进行调查，运用潜在剖面分析探究癌症相关认知障碍的潜在剖面，采用单因素分析、无序多分类Logistic回归分析探究癌症认知障碍病人潜在剖面的影响因素。

结果

癌症相关认知障碍病人可分为3个潜在剖面：高认知功能组（67.2%）、中等认知功能组（22.6%）、低认知功能组（10.1%）。无序多分类 Logistic 回归结果显示，文化程度、肿瘤分期、年龄、运动依从性、焦虑是肺癌病人认知功能潜在剖面的影响因素（均P<0.05）。

结论

肺癌病人癌症相关认知障碍存在群体异质性，提示医护人员可根据不同类别肺癌病人认知功能水平的影响因素，制定更具针对性的干预措施。

肺癌  /  认知功能  /  癌症相关认知障碍  /  潜在剖面分析  /  影响因素  /  肿瘤护理
Objective

To explore the latent profiles of cognitive function in lung cancer patients and their influencing factors.

Methods

A total of 296 lung cancer patients who visited the oncology department of a tertiary grade A hospital in Chongqing from January to August 2025 were selected as the survey subjects.General information questionnaire,Functional Assessment of Cancer Therapy-Cognitive Function Scale,Exercise Adherence Scale,and Self-Rating Anxiety Scale were used for investigation.Latent profile analysis was employed to explore the latent profiles of cancer-related cognitive impairment,while univariate analysis and multinomial Logistic regression analysis were used to investigate the influencing factors of latent profiles in cancer-related cognitive impairment patients.

Results

Cancer-related cognitive impairment patients could be classified into three latent profiles:high cognitive function group(67.2%),moderate cognitive function group(22.6%),and low cognitive function group(10.1%).Multinomial Logistic regression results showed that educational level,tumor stage,age,exercise adherence,and anxiety were influencing factors of latent profiles of cognitive function in lung cancer patients(all P<0.05).

Conclusions

Cancer-related cognitive function in lung cancer patients exhibits group heterogeneity.It suggests that healthcare professionals should develop more targeted intervention measures based on the influencing factors of different categories of lung cancer patients' cognitive function levels.

lung cancer  /  cognitive function  /  cancer-related cognitive impairment  /  latent profile analysis  /  influencing factors  /  oncology nursing
朱晓菊, 罗思熊, 付海炜, 关伟, 王宗华. 肺癌病人癌症相关认知障碍潜在剖面分析及影响因素. 护理研究, 2026 , 40 (9) : 1488 -1494 . DOI: 10.12102/j.issn.1009-6493.2026.09.008
Xiaoju ZHU, Sixiong LUO, Haiwei FU, Wei GUAN, Zonghua WANG. Latent profile analysis and influencing factors of cancer-related cognitive impairment in lung cancer patients[J]. Chinese Nursing Research, 2026 , 40 (9) : 1488 -1494 . DOI: 10.12102/j.issn.1009-6493.2026.09.008
正文
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全球癌症统计数据（GLOBOCAN）显示，2021年肺癌新发例数达250万例，死亡例数达181.7万例，发病率和死亡率已在恶性肿瘤中位于前列[1]，且其难治性病人往往背负极大的医疗负担[2]。在肺癌治疗过程中，病人常伴随癌症相关认知障碍（cancer-related cognition impairment，CRCI），可严重影响病人的日常生活、社会功能及治疗依从性[3]。癌症相关认知障碍是指由癌症及其治疗引发的认知障碍，病人常表现为记忆衰退、专注力下降及言语交流障碍等症状[4]。既往研究显示，癌症相关认知障碍在癌症病人群体中的发生率高达75%，约30%的病人症状可持续至治疗完成后的几个月到几年不等[5]。癌症相关认知障碍的发生可能受肿瘤本身、治疗方案、年龄、心理困扰等多种因素影响，但影响侧重可能存在差异[6-7]，既往研究多根据量表总分或维度得分判断病人的认知功能，忽视了病人的异质性，可能导致干预缺乏针对性[8-9]。潜在剖面分析（latent profile analysis，LPA）是基于模型的概率性聚类方法，能够依据病人在多个观测变量上的反应模式识别出潜在亚组，从而更精细地揭示群体内部的异质性[10]。因此，本研究采用潜在剖面分析系统探索肺癌病人癌症相关认知障碍的潜在剖面特征，并进一步分析其影响因素，以期为临床精准干预提供借鉴。
1　对象与方法
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1.1　研究对象
选取2025年1月—8月在重庆市某三级甲等医院肿瘤科就医的肺癌病人。纳入标准：经病理活检金标准确诊为原发性肺癌[11]；年龄18岁及以上；无精神疾病，可正常沟通；知情同意，并签署知情同意书；行化疗或化疗联合免疫治疗；前期暂未行放疗及靶向治疗。排除标准：经检查证实有颅脑肿瘤、脑卒中、癫痫等其他疾病引起的认知障碍者；言语、交流认知障碍，配合度欠佳；有神经系统疾病病史；采取保护性医疗者；前期已行放疗及靶向治疗者。根据Logistic回归每个预测变量至少5例结局事件（5 events per variable，5EPV)原则，结合拟探究的影响因素，并考虑到10%的无效样本，预计潜在剖面分析的最低类别占比为30%，至少需要296例病人。本研究共纳入307例样本，满足样本量要求。研究方案已通过医疗机构伦理审查委员会审批（医研伦审[2024]第94号），并在中国临床试验注册中心注册（ChiCTR2500100176）。
1.2　调查工具
1.2.1　一般资料调查表
根据文献查阅、研究目的及专家意见自行设计一般资料调查问卷。问卷包括性别、年龄、文化程度、工作状况、居住地、人均月收入、医保方式、有无转移、肿瘤分期、治疗周期、病理类型、合并症（高血压、糖尿病、冠心病等）。
1.2.2　癌症治疗功能评估-认知功能量表（Functional Assessment of Cancer Therapy Cognitive Function，FACT-Cog）
量表由Wagner等[12]编制、徐培镕等[13]汉化为中文版。FACT-Cog用于衡量过去1周内各种认知相关状况的发生频次，既往已广泛用于多种癌症病人群体中[13-14]。包含知觉的认知功能障碍（CogPCI）（20个条目）、知觉的认知能力（CogPCA）（9个条目）、对生活质量的影响（CogQOL）（4个条目）、其他人的评价语（CogOTH）（4个条目）。采用Likert 5级评分法。“从来没有”计0分，“一天几次”计4分，CogPCA维度采用正向计分，其余维度均采用反向计分。总分0~148分，分数越高代表主观认知功能表现越佳。中文版FACT-Cog总量表和各维度的Cronbach's α系数为0.84~0.97，重测信度为0.98[13]。本研究中，总量表和各维度的Cronbach's α系数为0.86~0.94。
1.2.3　运动依从性量表（The Exercise Adherence Rating Scale，EARS）
量表由Beaton等[15]编制、巫雨轩等[16]汉化，包含运动依从性评定和原因评定2个维度、16个条目。采用Likert 5级评分，总分0~64分，分值越高表示依从性越好。量表的Cronbach′s α系数为0.94，本研究中量表的Cronbach's α系数为0.92。
1.2.4　焦虑自评量表（Self-Rating Anxiety Scale，SAS）
采用由刘贤臣等[17]修订的焦虑自评量表，包含20个条目，采用Likert 4级评分法。通过将原始得分乘以1.25转换为标准分，总分为25~100分。焦虑程度的划分标准：<50分为正常，50~59分为轻度焦虑，60~69分为中度焦虑，≥70分为重度焦虑。量表的Cronbach′s α系数为0.82，本研究中量表的Cronbach′s α系数为0.84。
1.3　资料收集方法
本研究由经过统一培训的3名组长担任调查员。调查员仔细告知病人及家属本次调查的目的、内容及保密措施，在获得书面同意后实施。调查选择在科室示教室或安静病房进行，确保环境独立、安静。调查采用标准化流程：由调查员宣读统一指导语后，发放量表。对于有视力障碍或文化程度受限者，调查员逐题朗读，但不予引导性提示。问卷当场回收并核查，遗漏项目立即补填。质量控制采取以下措施：1）采用双人核对机制，1人负责调查，1人负责质量监督；2）所有量表使用前均进行编号登记；3）每日调查结束后由课题组长抽查10%的问卷质量。本研究共发放问卷307份，11例病人在调查中途要求离开，最终回收有效问卷296份，回收率为96.4%。
1.4　统计学方法
采用Mplus 8.3进行潜在剖面分析，以肺癌病人FACT-Cog的4个维度作为外显变量，依次拟合1~k类模型。潜在剖面模型拟合评价指标主要包括赤池信息准则（Akaike information criterion，AIC）、贝叶斯信息准则（Bayesian information criterion，BIC）、校正BIC（adjusted BIC，aBIC）、罗-梦戴尔-鲁本校正似然比检验（Lo-Mendell-Rubin test，LMRT）、基于Bootstrap 的似然比检验（Bootstrap likelihood ratio test，BLRT）和信息熵（Entropy），其中AIC、BIC、aBIC数值越小表明模型拟合越好；Entropy越接近 1，分类越清晰；LMRT、BLRT比较不同潜在剖面模型之间的差异，若P<0.05，支持k类比k-1类模型更优。采用SPSS 27.0进行统计分析，正态分布的定量资料以均数±标准差（x±s）表示，非正态分布的定量资料以中位数和四分位数[M(P25，P75)]表示，组间比较采用秩和检验；定性资料采用例数、百分比（%）表示，组间比较采用χ2检验，癌症相关认知障碍潜在剖面的影响因素采用单因素分析和无序多分类Logistic回归分析。检验水准α=0.05。
2　结果
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2.1　肺癌病人癌症相关认知障碍现状
296例肺癌病人癌症相关认知障碍总分为（117.23±10.98）分，条目均分为（3.16±0.30）分，各维度条目均分由高到低依次为CogOTH、CogQOL、CogPCI、CogPCA。见表1。
2.2　肺癌病人认知功能的潜在剖面分析结果
以FACT-Cog的4个维度为外显指标，依次选取1~4个潜在剖面对肺癌病人癌症相关认知障碍进行潜在剖面分析。随着剖面数目增加，Entropy均>0.80，AIC、BIC、aBIC逐渐变小且LMRT和BLRT在2~4个剖面模型均P<0.05。相比于2个剖面模型，3个剖面模型分类更加精细；3个剖面归属于该剖面的平均概率为 97.0%~98.7%，优于4个剖面模型。综合模型拟合指数和实际意义，本研究采用3个剖面模型作为最佳模型进行后续分析。见表2。根据3个剖面在FACT-Cog量表各条目的得分情况形成肺癌病人癌症相关认知障碍的潜在剖面图，见图1。剖面1共30例（10.1%），其癌症相关认知障碍评分最低，命名为“低认知功能组”；剖面2共67例（22.6%），癌症相关认知障碍得分均属于中等水平，命名为“中等认知功能组”；剖面3共199例（67.2%），其癌症相关认知障碍评分相对最高，且在所有维度中表现最优，故命名为“高认知功能组”。
2.3　肺癌病人癌症相关认知障碍潜在剖面影响因素的单因素分析
单因素分析显示，文化程度、肿瘤分期、病理类型、年龄、运动依从性、焦虑对肺癌病人癌症相关认知障碍的潜在剖面有影响（P<0.05），见表3。
2.4　肺癌病人癌症相关认知障碍潜在剖面影响因素的多因素分析
将单因素分析筛选出的因素纳入无序多分类Logistic回归模型中，以进一步探究癌症相关认知障碍潜在剖面的影响因素，结果显示，肿瘤分期、年龄、文化程度、运动依从性、焦虑程度是肺癌病人癌症相关认知障碍潜在剖面的影响因素（均P<0.05），见表4。
3　讨论
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3.1　肺癌病人癌症相关认知障碍现状及潜在剖面
本研究结果显示，肺癌病人癌症相关认知障碍总分为（117.23±10.98）分，条目均分为（3.16±0.30）分，说明病人癌症相关认知障碍总体处于中等水平，本研究结果与罗钰等[18]一致，但本研究中其内部维度并不均衡，知觉的认知能力和认知障碍得分偏低，说明肺癌病人对自身认知功能可能存在消极认知偏差，这可能源于疾病带来的心理困扰，焦虑、抑郁等负面情绪放大了对病人对认知衰退的感知。进一步对病人的认知功能进行潜在剖面分析，将病人癌症相关认知障碍划分为低认知功能组、中等认知功能组及高认知功能组3个亚组。从分组情况可以看出，虽然大部分病人认知水平相对较高，但仍有近30%的病人处于中低水平认知功能状态，提示认知受损在该群体中是一个不容忽视的问题。特别低认知功能组，占10.1%，其认知受损程度可能更为严重，是需要临床重点关注的高危人群。本结果证实了对病人癌症相关认知障碍进行精细化评估与分类的必要性，并为实施精准干预提供了依据：对于高认知功能组病人，干预策略应以认知促进与维持为主；对于中等认知功能组病人，需进行早期识别和针对性认知功能训练，以防功能进一步衰退；对于低认知功能组病人，则应采取综合性的强化康复与支持措施，并加强照护管理，提高生活质量。
3.2　肺癌病人癌症相关认知障碍影响因素
3.2.1　文化程度是癌症相关认知功能的保护因素
研究显示，与小学文化病人相比，拥有高中文化的病人归属于中等认知功能组和高认知功能组的可能性更高（OR值分别为6.073，4.434），而专科及以上文化程度的病人，其归属于高认知功能组的概率是小学文化程度病人的近10倍（OR=9.638），该结果与Ni[19]研究结果一致。个体在整个生命历程中通过教育、职业等智力活动所积累的神经连接与认知策略，能够在其大脑面临与疾病或衰老相关的病理损害时，提供一定程度的代偿，减缓认知衰退[20]。因此，对于文化程度较低的病人，是临床护理工作中应当重点监测与早期干预的对象。针对这一群体，建议强化后续的认知训练、生活方式干预（如促进身体活动、社会参与），以期在一定程度上弥补其认知储备的相对不足。
3.2.2　年龄是癌症相关认知功能的危险因素
年龄仅在高认知功能组与低认知功能组病人比较中有统计学意义（OR=0.925），表明随着年龄的增长，可能影响病人最优的认知表现。有研究表明，衰老可加速恶化癌症病人的基础炎症、血管功能和细胞修复能力，最终导致大脑功能紊乱，临床表现出更严重的认知障碍，降低病人认知功能的上限[21-22]。对于相对年轻或处于疾病早期的病人，临床干预核心目标是“维持巅峰”，即通过积极干预尽可能延长其处于高认知功能状态的时间，对抗年龄的侵蚀效应；对于高龄病人，护理重点则应转向提升底线，即通过强化教育、坚持体育锻炼、控制血管风险等手段，延缓其认知功能的进一步衰退。
3.2.3　运动依从性是癌症相关认知功能的保护因素
与低认知功能组相比，运动依从性越高的病人归属于中认知功能组（OR=1.314）和高认知功能组（OR=1.348）的可能性均更高，提示运动作为一种非药物干预，对于肺癌病人认知功能改善作用稳定，具有一定普适性。有研究指出，运动可以改善脑部代谢循环，升高脑源性神经营养因子水平，防止海马体、大脑皮层等部位的脑神经进一步退化，促进修复，因此，提升病人的运动依从性对于缓解与改善肺癌病人认知功能有重要意义[23-24]。在临床工作中，应鼓励病人养成规律运动的习惯，尤其在病人的院外管理过程中，应当充分动员家属，督促病人，提升运动依从性。
3.2.4　焦虑是癌症相关认知功能的危险因素
焦虑仅在高认知功能组与低认知功能组病人比较有统计学意义（OR=0.863）。既往研究显示，强烈的焦虑心理，可过度激活应激系统，导致皮质醇水平升高，对记忆中枢海马体产生神经毒性，损害认知功能[25-26]。此外，焦虑可导致神经递质失衡和睡眠障碍，进一步削弱大脑的信息处理与整合能力，加重认知衰退。因此，在肺癌病人的临床管理中，除了对病人进行认知功能评估，也应当同步进行负性心理筛查。在实际访谈调查时，发现肺癌病人由于其病情难治性，普遍存在较强的负面心理，可把心理教育和支持作为临床护理管理工作的一项重要内容，给予肺癌病人更多的心理支持。
3.2.5　肿瘤分期是癌症相关认知功能的危险因素
与低认知功能组相比，肿瘤分期为Ⅳ期的病人归属于高认知功能组的可能性更低，而在中等认知功能组与低认知功能组之间，肿瘤分期无统计学意义。目前，晚期肺癌难以采用根治术治疗，其治疗预期较低，这种严峻的疾病现实与不确定的未来，极易催生强烈的无力感、绝望感与死亡焦虑，从而引发更严重的焦虑、抑郁等负性心理。在临床护理中，针对高肿瘤分期的病人，在抗癌治疗的同时，应着重关注并积极干预其负性心理，保护认知功能，提升生活质量。
4　小结
收起
本研究通过潜在剖面分析将肺癌病人癌症相关认知障碍分为低认知功能组、中等认知功能组及高认知功能组3个潜在剖面，文化程度、肿瘤分期、年龄、运动依从性、焦虑是不同剖面的影响因素。提示医护人员可根据肺癌病人癌症相关认知障碍的不同类别，制定针对性的干预措施。此外，本研究的研究对象仅限于重庆市，可能会产生一定的地域局限性，而横断面的设计无法追踪个体认知状态的动态变化，未来研究应扩大样本量和样本来源，以提升研究结果的可推广性。

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2026年第40卷第9期
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doi: 10.12102/j.issn.1009-6493.2026.09.008
  • 接收时间：2025-12-11
  • 首发时间：2026-10-28
  • 出版时间：2026-05-10
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  • 收稿日期：2025-12-11
  • 修回日期：2026-03-19
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    1中国人民解放军陆军军医大学，重庆 400038
    2中国人民解放军陆军军医大学大坪医院
    3重庆市护士学校

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
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红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
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光柄菇属 Pluteus 5 2.39
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