Article(id=1322168931914207344, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322168481081049284, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.09.024, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1749744000000, receivedDateStr=2025-06-13, revisedDate=1768579200000, revisedDateStr=2026-01-17, acceptedDate=null, acceptedDateStr=null, onlineDate=1793159238078, onlineDateStr=2026-10-28, pubDate=1778342400000, pubDateStr=2026-05-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793159238078, onlineIssueDateStr=2026-10-28, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793159238078, creator=13701087609, updateTime=1793159238078, 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=1598, endPage=1602, ext={EN=ArticleExt(id=1322168932136505457, articleId=1322168931914207344, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Research progress on chemotherapy-related sleep disturbance in colorectal cancer from the perspective of symptom network theory, columnId=1220689485315101342, journalTitle=Chinese Nursing Research, columnName=Review Articles, runingTitle=null, highlight=null, articleAbstract=

It systematically reviewed the evolution of the definition,clinical manifestations, influencing factors, and interventions related to chemotherapy-induced sleep disturbance in colorectal cancer patients.Emphasizing a symptom network perspective,it highlighted the importance of identifying core and associated symptoms to guide more precise and individualized clinical management,thereby improving patients' sleep quality and overall quality of life.

, authors=Xiaodan AN1, Hui WANG2, Peilu FAN1, Lijun TAN1, Qi XIE1, Huiqin ZHAO1, Zhuowei RUAN2, Sanmei CHEN1, Jian FANG1, authorsList=Xiaodan AN, Hui WANG, Peilu FAN, Lijun TAN, Qi XIE, Huiqin ZHAO, Zhuowei RUAN, Sanmei CHEN, Jian FANG, authorCompany=null, correspAuthors=Jian FANG, 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=1322168932555935858, articleId=1322168931914207344, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=症状网络理论下结直肠癌病人化疗相关睡眠障碍的研究进展, columnId=1220689485482873504, journalTitle=护理研究, columnName=科研综述, runingTitle=null, highlight=null, articleAbstract=

系统梳理结直肠癌病人化疗相关睡眠障碍的定义演变、临床表现、影响因素及干预措施,强调从症状网络视角出发识别核心症状与关联症状,以指导更精准、个体化的临床管理,改善病人睡眠质量与整体生活质量。

, authors=安小丹1, 王惠2, 樊珮璐1, 谭丽君1, 谢齐1, 赵慧琴1, 阮卓薇2, 陈三妹1, 方剑1, *, *, authorsList=安小丹, 王惠, 樊珮璐, 谭丽君, 谢齐, 赵慧琴, 阮卓薇, 陈三妹, 方剑, authorCompany=null, correspAuthors=方剑, authorNote=

安小丹,护士,硕士研究生在读

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方剑,E-mail:
FANG Jian, E-mail:
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症状网络理论下结直肠癌病人化疗相关睡眠障碍的研究进展
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安小丹 1 , 王惠 2 , 樊珮璐 1 , 谭丽君 1 , 谢齐 1 , 赵慧琴 1 , 阮卓薇 2 , 陈三妹 1 , 方剑 1, *, *
护理研究 | 科研综述 2026,40(9): 1598-1602
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护理研究 |科研综述 2026 , 40 (9) : 1598 -1602
症状网络理论下结直肠癌病人化疗相关睡眠障碍的研究进展
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安小丹1, 王惠2, 樊珮璐1, 谭丽君1, 谢齐1, 赵慧琴1, 阮卓薇2, 陈三妹1, 方剑1, *, *
作者信息
  • 1绍兴文理学院医学院,浙江 312099
  • 2绍兴市人民医院/绍兴文理学院附属第一医院
通讯作者:
方剑,E-mail:
FANG Jian, E-mail:
作者简介:

安小丹,护士,硕士研究生在读

Research progress on chemotherapy-related sleep disturbance in colorectal cancer from the perspective of symptom network theory
Xiaodan AN1, Hui WANG2, Peilu FAN1, Lijun TAN1, Qi XIE1, Huiqin ZHAO1, Zhuowei RUAN2, Sanmei CHEN1, Jian FANG1
Affiliations
  • 1Medical College of Shaoxing University, Zhejiang 312099 China
  • 2Shaoxing People's Hospital/The First Affiliated Hospital of Shaoxing University
出版时间: 2026-05-10 doi: 10.12102/j.issn.1009-6493.2026.09.024
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系统梳理结直肠癌病人化疗相关睡眠障碍的定义演变、临床表现、影响因素及干预措施,强调从症状网络视角出发识别核心症状与关联症状,以指导更精准、个体化的临床管理,改善病人睡眠质量与整体生活质量。

结直肠癌  /  化疗  /  睡眠障碍  /  症状网络理论  /  综述

It systematically reviewed the evolution of the definition,clinical manifestations, influencing factors, and interventions related to chemotherapy-induced sleep disturbance in colorectal cancer patients.Emphasizing a symptom network perspective,it highlighted the importance of identifying core and associated symptoms to guide more precise and individualized clinical management,thereby improving patients' sleep quality and overall quality of life.

colorectal cancer  /  chemotherapy  /  sleep disturbance  /  symptom network theory  /  review
安小丹, 王惠, 樊珮璐, 谭丽君, 谢齐, 赵慧琴, 阮卓薇, 陈三妹, 方剑. 症状网络理论下结直肠癌病人化疗相关睡眠障碍的研究进展. 护理研究, 2026 , 40 (9) : 1598 -1602 . DOI: 10.12102/j.issn.1009-6493.2026.09.024
Xiaodan AN, Hui WANG, Peilu FAN, Lijun TAN, Qi XIE, Huiqin ZHAO, Zhuowei RUAN, Sanmei CHEN, Jian FANG. Research progress on chemotherapy-related sleep disturbance in colorectal cancer from the perspective of symptom network theory[J]. Chinese Nursing Research, 2026 , 40 (9) : 1598 -1602 . DOI: 10.12102/j.issn.1009-6493.2026.09.024
结直肠癌(colorectal cancer,CRC)是全球重大公共卫生问题。全球癌症统计报告(GLOBOCAN) 2024年数据显示,结直肠癌发病率(9.3%)和死亡率(9.6%)分别居全球恶性肿瘤第3位和第2位,预计到2030年新发病例将超190万例,死亡病例达90.4万例[1]。中国作为结直肠癌高发国家,2022年新发病例51.71万例,死亡24万例,发病率及死亡率均居国内肿瘤前5位[2]。目前,手术联合化疗虽为一线方案[3],但化疗不良反应突出,其中睡眠障碍尤为常见且具高致衰性[4]。因此,关注结直肠癌化疗病人的睡眠障碍具有重要临床与社会价值。结直肠癌化疗病人常出现失眠、嗜睡等多类型睡眠障碍,受化疗毒性、心理及病理生理因素共同影响,可与疲乏、抑郁、疼痛等构成多症状网络。然而,现有研究多将睡眠障碍视为单一症状,忽略其内部异质性及与其他症状的动态关联,限制了对其复杂机制的系统理解。心理学中症状网络理论强调精神病理源于症状间相互作用[5],为识别结直肠癌化疗病人睡眠障碍核心症状、解析表型异质性及其临床症状关联提供了新视角。现基于该理论探讨其表型分类、影响因素及关联症状,旨在为个性化管理和提升病人睡眠质量与生活质量提供依据。
近年来,睡眠障碍问题备受关注,但迄今尚未检索到有关睡眠障碍的定义共识,其概念演变可从以下3种路径阐述。第一,从症状表现角度出发,聚焦睡眠状态异常而非病因。1990年国际睡眠障碍分类(International Classification of Sleep Disorders,ICSD)将睡眠障碍定义为主要与睡眠和清醒障碍有关的疾病,以及在睡眠中侵入或发生的疾病,虽具启发性但难以区分病理性睡眠问题与普通睡眠问题。第二,基于实用诊断分类的角度,强调临床标准化。ICSD-3将睡眠障碍简化为失眠、呼吸相关障碍等8类,简化诊断路径,弱化对统一病理机制依赖[6],但该框架为医生主导的标准化诊断,未充分体现以病人为中心的个体化差异。第三,基于功能损害视角,将潜在有害病因及其实质功能损害引入睡眠障碍定义[7],强调潜在病因及其造成的实质性功能损害,有助于理解病理机制,却易忽视症状的交互作用和症状自身维持机制。
为突破传统定义的局限,Gauld等[8]首创性地将症状网络理论引入睡眠障碍研究,从症状相互作用和纵向网络强化两个维度,提出全新定义:睡眠障碍是由一组核心症状(如失眠、嗜睡、非恢复性睡眠、异常行为)及相关症状构成的病理性症状网络系统,该系统中至少包含1个有害症状。症状相互强化形成稳定病态结构,需有效干预方可打破。2025年,Gauld等[9]进一步引入感知因果网络模型解释睡眠障碍的动态演化机制。模型指出,短睡眠等外部因素与症状存在反馈循环,驱动系统向高度稳态的病态结构演化。基于症状网络理论,睡眠障碍的临床表型可分为内部核心症状和外部相关症状,强调两者在其发生与维持过程中的关键作用。
睡眠障碍包括失眠、嗜睡、非恢复性睡眠和异常睡眠行为4个核心症状。结直肠癌化疗病人睡眠障碍研究主要聚焦失眠与嗜睡,非恢复性睡眠常被归入失眠,异常睡眠行为则归入觉醒障碍与异态睡眠,相关研究明显不足[10-11]。
研究表明,失眠在结直肠癌化疗病人中高发,其主要表现为入睡困难、睡眠维持困难、睡眠质量下降及早醒[12],严重影响躯体功能、情绪、认知功能及生活质量。一项横断面研究显示,结直肠癌化疗病人失眠发生率达66.7%,平均睡眠时间不足5.5 h,入睡延迟达1 h,近9%病人日间功能受损[13]。国内研究亦证实结直肠癌病人睡眠障碍发生率达86%,高于胃癌等其他肿瘤类型,且失眠与化疗相关疼痛及认知功能下降密切相关[14]。提示化疗引发生理不适可损害睡眠质量,加重失眠症状,影响病人的生存质量。此外,失眠与生理症状间存在双向关系:前者可诱发或加重不适,后者亦可加剧失眠。日本一项研究基于恶心影响中枢神经系统的先验假设表明恶心症状显著影响结直肠癌中围化疗病人夜间睡眠和生活质量[15],进一步证实生理不适与睡眠障碍的密切关联。然而,化疗所致生理症状在睡眠障碍发生与演化中的机制研究仍较缺乏,亟待进一步系统探讨。
ICSD-3将嗜睡症定义为无法抑制的睡眠需求或白天陷入睡眠,包括白天过度嗜睡(excessive daytime sleepiness,EDS)、过度睡眠需求、Ⅰ/Ⅱ型发作性睡病和特发性睡病。其中白天过度嗜睡是癌症病人中最常见的类型[16],表现为白天明显嗜睡,即便夜间睡眠充足仍感疲乏,提示睡眠功能受损,其具有重要临床警示意义。Katada等[17]报告1例转移性结肠癌病人在化疗中出现明显嗜睡、意识模糊并最终因后部可逆性脑病综合征进展为脑梗死,提示嗜睡或为神经毒性、脑血管事件的早期预警。白天过度嗜睡对病人生存结局具有潜在影响。一项前瞻性研究发现,Ⅲ期结肠癌病人中白天过度嗜睡频率越高,癌症特异性死亡风险越大,几乎每日受其困扰者死亡风险为未受影响者的2.97倍[18]。尽管嗜睡在结直肠癌化疗病人中普遍存在并影响预后,相关研究仍有限。此外,嗜睡与失眠常呈协同强化关系:白天嗜睡可能导致失眠,而失眠亦是导致嗜睡的重要诱因[19]。
疲劳、抑郁等心理症状与睡眠障碍常并存构成高度耦合症状群,损害病人身心健康与认知功能。美国墨菲特癌症中心提出“疲乏-睡眠障碍-抑郁症状群”[20],认为其在多个癌种中均为常见共病模式,该症状群具动态性,表现形式随治疗阶段变化,有时仅呈现部分症状,因此,现有结直肠癌化疗研究多聚焦其两两关系。Liu等[21]的2周纵向研究发现,抑郁与失眠相关,长期负面情绪可损害睡眠质量。另一项交叉滞后网络分析研究显示,结直肠癌术后辅助治疗病人疲乏程度受睡眠障碍影响,提示二者存在双向反馈机制[22]。
结直肠癌化疗病人睡眠障碍的临床复杂性不仅与核心症状(失眠、嗜睡)及心理症状交互作用有关,还与化疗相关副作用,尤其是化疗诱导性周围神经病变(chemotherapy-induced peripheral neuropathy,CIPN)密切相关。CIPN发生率高达50%~90%,其中30%~40%的病人可能进展为不可逆的慢性神经损伤[23],目前仅能依赖度洛西汀等药物缓解疼痛,长期损害病人生存质量。已有研究证实CIPN与睡眠障碍存在关联。Bonhof等[24]研究显示,CIPN病人夜间觉醒次数增加,且唯一常用药物度洛西汀可能通过5-羟色胺机制加剧睡眠碎片化,提示CIPN或为结直肠癌化疗后睡眠障碍的驱动因素,对病人睡眠问题造成长期负面影响。尽管近年来结直肠癌化疗病人CIPN与睡眠障碍研究增多,但该领域仍存在以下不足。1)因果方向模糊:研究仅将睡眠障碍视为CIPN诱因,忽视CIPN可通过慢性疼痛、感觉异常等机制反向加重睡眠障碍[25],二者双向关系及主导路径尚不清晰;2)适用人群偏倚:现有证据多基于乳腺癌病人缺乏结直肠癌特异性证据,限制结果的外推性和指导价值;3)本土研究薄弱:尽管国际研究逐渐深入,国内相关研究仍匮乏且多聚焦糖尿病与CIPN关联,忽视其与睡眠障碍的关系,成因可能系前期重视不足。综上,CIPN作为结直肠癌化疗后高发的慢性副反应,其与睡眠障碍的双向影响亟待重视。加强对国内结直肠癌人群CIPN与睡眠障碍关系的系统研究,对提升病人治疗后症状管理及改善长期生活质量具重要临床意义。
“3P”模型[易感因素(predisposing factors)、诱发因素(precipitating factors)、维持因素(perpetuating factors)]为解析多因素作用下的睡眠障碍提供理论基础[26]。
诱发因素指促使睡眠障碍发生负性事件或压力性事件,在事件发生后睡眠问题随之出现。化疗过程本身是结直肠癌病人最主要的诱发因素。研究发现,化疗首个月病人的睡眠质量最差,随着对治疗的适应逐渐改善[27]。但Zhang等[28]的研究指出,在化疗的第3个月(即第4周期的化疗阶段)睡眠障碍发生率达到高峰,提示该阶段为睡眠问题的高风险窗口期,应加强识别与干预。
维持因素指在去除诱发因素后仍持续影响睡眠的机制。结直肠癌化疗病人主要维持因素包括癌症复发恐惧(fear of cancer recurrence,FCR)、社会支持系统缺失和反刍、担忧和灾难化思维。1)癌症复发恐惧:据调查约46.6%的结直肠癌病人存在明显的癌症复发恐惧[29],易引发负面情绪并干扰睡眠;2)社会支持系统缺失,结直肠癌化疗病人的社会支持度普遍低于乳腺癌和胃癌病人,其脆弱性加剧睡眠障碍[30];3)反刍、担忧和灾难化思维:根据失眠认知行为模型,反刍、担忧和灾难化思维会形成焦虑-失眠的恶性循环,是认知行为干预的重要靶点[31-32]。尽管这些维持因素在睡眠障碍的永久化发生中扮演关键角色,但目前结直肠癌化疗病人的相关研究仍较缺乏。未来应重视在临床实践中对上述因素的系统评估与干预,以打断睡眠障碍的维持路径。
易感因素指因个体背景特征而发生睡眠障碍的因素,主要包括性别、年龄、社会经济等。Wong等[32]发现,年轻结直肠癌化疗病人失眠风险更高,年龄<45岁组48.6%的病人报告具有临床意义的失眠,显著高于≥85岁人群(28.5%)。这一结果与传统“老年人睡眠更差”认知相悖,该现象可能与中青年群体面临更大的社会心理压力(如职业发展、家庭育儿压力)有关。在社会经济层面,经济负担重与家庭满意度低被证实为睡眠障碍的独立风险因素[33]。女性、中青年群体以及社会经济负担较重者是结直肠癌化疗病人中需特别关注的高风险人群,提示临床干预应考虑病人背景差异,实施针对性的分层管理。
结直肠癌化疗病人睡眠障碍呈慢性化发展趋势,临床倾向长期非药物干预,但现有研究多靶向评估和干预整体睡眠质量,缺乏症状分型,故现主要总结整体性干预措施。
运动被广泛认为有助于缓解睡眠障碍,其中有氧运动是当前研究的主要干预形式。Brown等[34]将39例参与者分为常规护理组、低剂量运动组(每周150 min)和高剂量运动组(每周300 min),持续干预6个月后结果显示,较高运动剂量可显著改善参与者的身体健康、生活质量、睡眠质量和疲乏感,呈现出明显剂量-反应关系,证实运动改善睡眠障碍的可行性。高强度有氧间歇训练(high-intensity aerobic interval training,HIIT)和阻力训练(resistance training,RES)在癌症病人中也展现出有利作用。Piraux等[35]研究显示,在直肠癌病人新辅助放化疗期间,高强度有氧间歇训练和阻力训练具有良好的安全性与依从性,为其推广应用提供了可行性依据。但运动干预的效果并不总是一致,运动对睡眠的改善可受到“地板效应”的影响,且其难以干预由认知行为因素导致的睡眠问题[36],其改善机制主要依赖光照暴露与昼夜节律[37],高频率和高强度锻炼对结直肠癌化疗病人可能构成生理负担。因此,运动干预虽具潜力但难以作为单一方案解决病人睡眠障碍问题。未来应探索运动与其他干预手段的联合路径,以提升整体干预效果和个体适应性。
认知行为疗法是一种结构化、系统化的心理治疗方法,可有效弥补运动干预在处理认知行为因素导致睡眠障碍方面的局限性。近年来,认知行为疗法被简化与数字化来提高其可及性和临床应用性,包括行为激活(behavioral activation,BA)和合理情绪行为疗法(rational emotional behavior therapy,REBT)等形式,在保留认知行为疗法核心干预逻辑的基础上具备操作更具简便性与成本效益。认知行为疗法在结直肠癌化疗病人睡眠障碍中的疗效已初步证实。一项两臂随机对照研究纳入101例结直肠癌病人,对行为激活干预组提供为期8周的激活课程(共8次课,包括5个专题课和3个重复课,每次30~50 min专业指导联合家庭作业),研究发现在干预4周即有改善,干预结束时,行为激活组在睡眠质量、生活质量和心理痛苦方面均优于常规护理组[38]。一项荟萃分析支持认知行为疗法在癌症病人中的广泛适用性[39],认知行为疗法在失眠严重程度、睡眠质量、睡眠潜伏期、睡眠效率、卧床时间等指标上均具有改善作用。尽管认知行为疗法干预效果显著,但近年来亦有研究对其提出反思[40],指出以下值得关注的问题:干预频率是否需个体化调整;治疗目标是否从“睡眠本身”拓展至“整体身心健康”;病人依从性应如何界定与提升。因此,认知行为疗法虽是非药物干预的重要手段,但在临床实践中不宜将其视为唯一优选。未来应根据具体目标和病人特征灵活选择认知行为疗法干预方案,关注其长期效果与现实适配性,实现真正以病人为中心的睡眠管理策略。
为应对认知行为疗法在依从性方面的局限,中医干预作为一种依从性高的方案,提供了有效补充路径[41]。中医干预基于整体观念和辨证论治,强调通过调和脏腑、通顺经络、平衡气血等方式改善睡眠障碍。其中外治法通过刺激任脉、冲脉等关键经脉,调节身体内平衡,实现睡眠改善[42]。在具体手段上,耳穴压豆疗法通过刺激耳部特定穴位(耳中、肾、内分泌和心脏),调理脏腑促进睡眠[43]。赵姣妮等[44]在40例直肠癌病人中实施该疗法,结果显示干预组较对照组在失眠缓解速度与夜间睡眠时长(约延长1.8 h)方面明显改善(P<0.05)。穴位按摩同样展现出良好疗效。一项为期4周的随机对照试验对60例接受结肠癌和胰腺癌化疗病人实施穴位按压(神门、足三里、三阴交、合谷),每次2 min,每周4次,结果显示,该方法可有效减轻接受化疗结肠癌或胰腺癌病人的睡眠障碍,具有安全、易实施、成本低等优势[45]。
结直肠癌化疗病人普遍存在睡眠障碍,其内部核心症状多样,常与焦虑、抑郁等外部相关症状共同形成复杂的多症状共存网络。该网络动态演化,受易感因素、维持因素和诱发因素共同驱动。尽管现有干预在缓解睡眠障碍整体或单一突出症状方面取得一定成效,但针对症状网络间动态相互强化机制的研究与干预仍显不足。基于此提出以下建议:1)聚焦睡眠障碍关键维持机制,优化干预靶点。护理干预应由单一症状缓解转向聚焦“维持因素”的综合策略,结合化疗过程中高风险时间窗精准识别睡眠障碍由“急性诱发”向“慢性维持”演化的关键节点,实现前移式干预。2)明确核心症状联动机制,实施网络干预策略。症状网络视角下睡眠障碍内部核心症状与外部相关症状协同强化,应基于联动机制开展精准干预,针对关键症状的互动关系,提升护理干预靶向性与系统性。3)关注症状动态轨迹,开展动态前瞻干预。结直肠癌化疗病人睡眠障碍存在随时间与治疗阶段变化的动态特征,建议通过动态网络分析识别各阶段内外部核心症状。借助复杂干预设计理念[46],制定阶段性、可调节的干预策略,使干预内容与病人实际状态匹配。结直肠癌化疗相关睡眠障碍呈现出“内外症状联动、相互强化”的网络特征,构建动态响应的个体化干预体系,对提升睡眠质量与整体生活质量具有重要临床价值。

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doi: 10.12102/j.issn.1009-6493.2026.09.024
  • 接收时间:2025-06-13
  • 首发时间:2026-10-28
  • 出版时间:2026-05-10
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  • 收稿日期:2025-06-13
  • 修回日期:2026-01-17
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    1绍兴文理学院医学院,浙江 312099
    2绍兴市人民医院/绍兴文理学院附属第一医院

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FANG Jian, E-mail:
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2种不同金属材料的力学参数
科
Family
属数
Number of
genus
种数
Number of
species
占总种数比例
Percentage of
total species (%)
属
Genus
种数
Number of
species
占总种数比例
Percentage of total
species (%)
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
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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