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Article(id=1322936876897804532, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.11.008, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1758988800000, receivedDateStr=2025-09-28, revisedDate=1777046400000, revisedDateStr=2026-04-25, acceptedDate=null, acceptedDateStr=null, onlineDate=1793342330430, onlineDateStr=2026-10-30, pubDate=1781020800000, pubDateStr=2026-06-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793342330430, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793342330430, creator=13701087609, updateTime=1793342330430, updator=13701087609, issue=Issue{id=1322936785516503921, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='11', pageStart='1809', pageEnd='2000', issueExtLink='null', onlineDate='null', pubDate='1781020800000', pubDateStr='2026-06-10', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793342308644, creator='13701087609', updateTime=1793343121351, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940194344796237, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940194344796238, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322936785516503921, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=1868, endPage=1874, ext={EN=ArticleExt(id=1322936878219010293, articleId=1322936876897804532, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Latent class analysis of post-traumatic growth in patients with endometrial cancer, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To explore the latent classes of post-traumatic growth in patients with endometrial cancer,and to analyze the influencing factors of different categories.

Methods

Convenience sampling method was used to select 263 patients with endometrial cancer hospitalized from June 2022 to June 2024 in our hospital.The General Information Questionnaire,Posttraumatic Growth Inventory(PTGI),Chinese version of Event Related Rumination Inventory(C-ERRI),Patient Health Questionnaire-9(PHQ-9) were used to investigate. Latent class analysis was used to identify categories of post-traumatic growth in patients with endometrial cancer.Logistic regression was used to analyze the influencing factors of posttraumatic growth in patients with different categories of endometrial cancer.

Results

The post-traumatic growth of endometrial cancer were characterized by negative coping,psychological smoothness,and positive growth.Logistic regression analyses results showed that BMI,level of purposeful rumination,and depressive symptoms were the influencing factors of post-traumatic growth in patients with different categories of endometrial cancer.

Conclusions

Clinical staff should carry out stratified interventions based on different category characteristics to optimize patient psychological outcomes.Clinical staff should implement precise management of patients based on the influencing factors of different categories of post-traumatic growth,combine with the specificity of post-traumatic growth patterns,improve mental health outcomes of patients.

, authors=Na DONG, Xianping DONG, Yingjie LIU, Xinyu LI, authorsList=Na DONG, Xianping DONG, Yingjie LIU, Xinyu LI, authorCompany=null, correspAuthors=Na DONG, 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=1322936879091425528, articleId=1322936876897804532, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=子宫内膜癌病人创伤后成长潜在类别分析, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

探讨子宫内膜癌（EC）病人创伤后成长的潜在类别，并分析不同类别的影响因素。

方法

采用便利抽样法，选取2022年6月—2024年6月于我院住院治疗的263例子宫内膜癌病人作为研究对象。使用一般资料调查表、创伤后成长量表（PTGI）、简体中文版事件相关反刍性沉思问卷（C-ERRI）、9项病人健康问卷（PHQ-9）进行调查。采用潜在类别分析识别子宫内膜癌病人创伤后成长类别，采用Logistic回归分析探讨不同类别子宫内膜癌病人创伤后成长的影响因素。

结果

子宫内膜癌病人创伤后成长分为消极应对型、心理平稳型及积极成长型。Logistic回归分析结果显示，体质指数、目的性反刍性沉思水平、抑郁症状是子宫内膜癌病人不同类别创伤后成长的影响因素。

结论

子宫内膜癌病人创伤后成长整体处于中等水平，且存在明显个体差异。临床工作者应依据不同类别特征开展分层干预，以优化病人心理结局。

, authors=董娜, 董仙萍, 刘英杰, 厉昕妤, authorsList=董娜, 董仙萍, 刘英杰, 厉昕妤, authorCompany=null, correspAuthors=董娜, authorNote=null, correspAuthorsNote=
DONG Na, E-mail:
董娜，主管护师，本科，E-mail：
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figs=[ArticleFig(id=1322936884145561883, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=EN, label=Figure 1, caption=The scores of each potential category of post-traumatic growth in patients with endometrial cancer on each dimension, figureFileSmall=xO1UnPFFN5xMaxtGSTWr2w==, figureFileBig=W0Nw21L/e6as8AV0MBxVYA==, tableContent=null), ArticleFig(id=1322936884426580252, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=CN, label=图1, caption=子宫内膜癌病人创伤后成长潜在类别在各维度上的得分, figureFileSmall=xO1UnPFFN5xMaxtGSTWr2w==, figureFileBig=W0Nw21L/e6as8AV0MBxVYA==, tableContent=null), ArticleFig(id=1322936884795679005, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=EN, label=Table 1, caption=

The correlation between post-traumatic growth,rumination,and depression in patients with endometrial cancer（r value）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目PTGIC-ERRIPHQ-9得分
自我改变人生感悟新的可能性与他人关系个人力量总分侵入性反刍性沉思目的性反刍性沉思总分
PTGI 自我改变1.000
人生感悟0.812①1.000
新的可能性0.480①0.805①1.000
与他人关系0.587①0.693①0.577①1.000
个人力量0.623①0.751①0.677①0.701①1.000
总分0.836①0.967①0.836①0.791①0.844①1.000
C-ERRI 侵入性反刍性沉思-0.086-0.049-0.009-0.0520.005-0.0481.000
目的性反刍性沉思0.488①0.708①0.767①0.496①0.622①0.726①-0.0431.000
总分0.163①0.304①0.369①0.197①0.310①0.314①0.871①0.453①1.000
PHQ-9得分-0.234①-0.188①-0.135①-0.178①-0.183①-0.213①0.409①-0.210①0.261①1.000
), ArticleFig(id=1322936884908925214, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=CN, label=表1, caption=

子宫内膜癌病人创伤后成长、反刍性沉思以及抑郁的相关性（r值）

, figureFileSmall=null, figureFileBig=null, tableContent=
项目PTGIC-ERRIPHQ-9得分
自我改变人生感悟新的可能性与他人关系个人力量总分侵入性反刍性沉思目的性反刍性沉思总分
PTGI 自我改变1.000
人生感悟0.812①1.000
新的可能性0.480①0.805①1.000
与他人关系0.587①0.693①0.577①1.000
个人力量0.623①0.751①0.677①0.701①1.000
总分0.836①0.967①0.836①0.791①0.844①1.000
C-ERRI 侵入性反刍性沉思-0.086-0.049-0.009-0.0520.005-0.0481.000
目的性反刍性沉思0.488①0.708①0.767①0.496①0.622①0.726①-0.0431.000
总分0.163①0.304①0.369①0.197①0.310①0.314①0.871①0.453①1.000
PHQ-9得分-0.234①-0.188①-0.135①-0.178①-0.183①-0.213①0.409①-0.210①0.261①1.000
), ArticleFig(id=1322936884984422687, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=EN, label=Table 2, caption=

Latent class model adaptation indicators for post-traumatic growth in patients with endometrial cancer

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类别AICBICaBICEntropyLMRT（P）类别概率（%）
类别111 418.28411 479.38911 433.035
类别210 827.40510 984.12810 886.2190.844<0.00147/53
类别310 711.40310 833.93810 737.9380.853<0.00133/45/22
类别410 834.20710 894.39010 748.8390.879<0.00131/41/9/19
类别510 908.83010 872.37410 822.8300.822<0.00123/14/35/7/21
), ArticleFig(id=1322936885059920160, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=CN, label=表2, caption=

子宫内膜癌病人创伤后成长的潜在类别模型适配指标

, figureFileSmall=null, figureFileBig=null, tableContent=
类别AICBICaBICEntropyLMRT（P）类别概率（%）
类别111 418.28411 479.38911 433.035
类别210 827.40510 984.12810 886.2190.844<0.00147/53
类别310 711.40310 833.93810 737.9380.853<0.00133/45/22
类别410 834.20710 894.39010 748.8390.879<0.00131/41/9/19
类别510 908.83010 872.37410 822.8300.822<0.00123/14/35/7/21
), ArticleFig(id=1322936885223498017, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=EN, label=Table 3, caption=

Univariate analysis of potential category influencing factors on post-traumatic growth in patients with endometrial cancer

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类消极应对组（n=86）心理平稳组（n=118）积极成长组（n=59）统计值P
年龄（岁）56.34±7.1455.72±6.5354.69±5.92F=1.0820.340
体质指数（kg/m2）21.94±4.2222.75±3.1223.65±2.53F=4.4520.013
婚姻状况[例（%）]未婚/离异/丧偶13（15.1）5（4.2）2（3.4）0.006①
已婚73（84.9）113（95.8）57（96.6）
受教育程度[例（%）]小学及以下23（26.7）38（32.2）24（40.7）
初中/高中40（46.5）61（51.7）20（33.9）χ2=7.9110.095
专科及以上23（26.7）19（16.1）15（25.4）
家庭人均月收入[例（%）]≤3 000元43（50.0）56（47.5）33（55.9）
>3 000~<5 000元19（22.1）39（33.1）17（28.8）χ2=5.6180.230
≥5 000元24（27.9）23（19.5）9（15.3）
肿瘤复发[例（%）]否53（61.6）86（72.9）35（59.3）χ2=4.4020.111
是33（38.4）32（27.1）24（40.7）
癌症分期[例（%）]Ⅰ期14（16.3）20（16.9）9（15.3）
Ⅱ期24（27.9）24（20.3）9（15.3）χ2=3.9050.419
Ⅲ期或Ⅳ期48（55.8）74（62.7）41（69.5）
病理分化程度[例（%）]低分化32（37.2）34（28.8）19（32.2）
中分化45（52.3）70（59.3）38（64.4）χ2=5.1070.276
高分化9（10.5）14（11.9）2（3.4）
化疗[例（%）]否31（36.0）31（26.3）17（28.8）χ2=2.3160.314
是55（64.0）87（73.7）42（71.2）
放疗[例（%）]否35（40.7）37（31.4）18（30.5）χ2=2.3940.302
是51（59.3）81（68.6）41（69.5）
C-ERRI总分（分）29.60±10.6930.52±7.9733.95±7.85F=4.4420.013
目的性反刍性沉思（分）18.64±4.0021.66±3.3926.10±3.01F=78.434<0.001
侵入性反刍性沉思（分）10.97±4.398.86±3.267.85±3.21F=3.0110.051
PHQ-9得分（分）7.97±5.146.37±4.383.92±1.63F=11.793<0.001
), ArticleFig(id=1322936886859276579, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=CN, label=表3, caption=

子宫内膜癌病人创伤后成长潜在类别影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
项目分类消极应对组（n=86）心理平稳组（n=118）积极成长组（n=59）统计值P
年龄（岁）56.34±7.1455.72±6.5354.69±5.92F=1.0820.340
体质指数（kg/m2）21.94±4.2222.75±3.1223.65±2.53F=4.4520.013
婚姻状况[例（%）]未婚/离异/丧偶13（15.1）5（4.2）2（3.4）0.006①
已婚73（84.9）113（95.8）57（96.6）
受教育程度[例（%）]小学及以下23（26.7）38（32.2）24（40.7）
初中/高中40（46.5）61（51.7）20（33.9）χ2=7.9110.095
专科及以上23（26.7）19（16.1）15（25.4）
家庭人均月收入[例（%）]≤3 000元43（50.0）56（47.5）33（55.9）
>3 000~<5 000元19（22.1）39（33.1）17（28.8）χ2=5.6180.230
≥5 000元24（27.9）23（19.5）9（15.3）
肿瘤复发[例（%）]否53（61.6）86（72.9）35（59.3）χ2=4.4020.111
是33（38.4）32（27.1）24（40.7）
癌症分期[例（%）]Ⅰ期14（16.3）20（16.9）9（15.3）
Ⅱ期24（27.9）24（20.3）9（15.3）χ2=3.9050.419
Ⅲ期或Ⅳ期48（55.8）74（62.7）41（69.5）
病理分化程度[例（%）]低分化32（37.2）34（28.8）19（32.2）
中分化45（52.3）70（59.3）38（64.4）χ2=5.1070.276
高分化9（10.5）14（11.9）2（3.4）
化疗[例（%）]否31（36.0）31（26.3）17（28.8）χ2=2.3160.314
是55（64.0）87（73.7）42（71.2）
放疗[例（%）]否35（40.7）37（31.4）18（30.5）χ2=2.3940.302
是51（59.3）81（68.6）41（69.5）
C-ERRI总分（分）29.60±10.6930.52±7.9733.95±7.85F=4.4420.013
目的性反刍性沉思（分）18.64±4.0021.66±3.3926.10±3.01F=78.434<0.001
侵入性反刍性沉思（分）10.97±4.398.86±3.267.85±3.21F=3.0110.051
PHQ-9得分（分）7.97±5.146.37±4.383.92±1.63F=11.793<0.001
), ArticleFig(id=1322936886943162660, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=EN, label=Table 4, caption=

Variable assignment status

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项目赋值方式
体质指数原值输入
婚姻状况已婚=0，未婚/离异/丧偶=1
C-ERRI总分原值输入
目的性反刍性沉思得分原值输入
PHQ-9得分原值输入
), ArticleFig(id=1322936886997688613, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=CN, label=表4, caption=

变量赋值情况

, figureFileSmall=null, figureFileBig=null, tableContent=
项目赋值方式
体质指数原值输入
婚姻状况已婚=0，未婚/离异/丧偶=1
C-ERRI总分原值输入
目的性反刍性沉思得分原值输入
PHQ-9得分原值输入
), ArticleFig(id=1322936887073186086, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=EN, label=Table 5, caption=

Multivariate analysis of potential category influencing factors on post-traumatic growth in patients with endometrial cancer

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潜在类别变量回归系数标准误Wald χ2值POR值95%CI
消极应对组常数17.5772.65343.789<0.001
体质指数-0.1820.0755.8340.0160.834[0.720，0.966]
目的性反刍性沉思得分-0.6210.07863.784<0.0010.537[0.461，0.626]
PHQ-9得分0.1560.0519.3640.0021.168[1.068，1.291]
心理平稳组常数12.4142.38527.087<0.001
目的性反刍性沉思得分-0.3880.06338.315<0.0010.679[0.600，0.767]
PHQ-9得分0.1040.0455.3240.0211.110[1.016，1.213]
), ArticleFig(id=1322936887148683559, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322936876897804532, language=CN, label=表5, caption=

子宫内膜癌病人创伤后成长潜在类别影响因素的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
潜在类别变量回归系数标准误Wald χ2值POR值95%CI
消极应对组常数17.5772.65343.789<0.001
体质指数-0.1820.0755.8340.0160.834[0.720，0.966]
目的性反刍性沉思得分-0.6210.07863.784<0.0010.537[0.461，0.626]
PHQ-9得分0.1560.0519.3640.0021.168[1.068，1.291]
心理平稳组常数12.4142.38527.087<0.001
目的性反刍性沉思得分-0.3880.06338.315<0.0010.679[0.600，0.767]
PHQ-9得分0.1040.0455.3240.0211.110[1.016，1.213]
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子宫内膜癌病人创伤后成长潜在类别分析
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董娜 , 董仙萍 , 刘英杰 , 厉昕妤
护理研究 | 科研论著 2026,40(11): 1868-1874
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护理研究 |科研论著 2026 , 40 (11) : 1868 -1874
子宫内膜癌病人创伤后成长潜在类别分析
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董娜 , 董仙萍, 刘英杰, 厉昕妤
作者信息
  • 1唐山市妇幼保健院，河北 063003
通讯作者:
DONG Na, E-mail:
董娜，主管护师，本科，E-mail：
Latent class analysis of post-traumatic growth in patients with endometrial cancer
Na DONG , Xianping DONG, Yingjie LIU, Xinyu LI
Affiliations
  • 1Tangshan Maternal and Child Health Hospital, Hebei 063003 China
出版时间: 2026-06-10 doi: 10.12102/j.issn.1009-6493.2026.11.008
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摘要
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目的

探讨子宫内膜癌（EC）病人创伤后成长的潜在类别，并分析不同类别的影响因素。

方法

采用便利抽样法，选取2022年6月—2024年6月于我院住院治疗的263例子宫内膜癌病人作为研究对象。使用一般资料调查表、创伤后成长量表（PTGI）、简体中文版事件相关反刍性沉思问卷（C-ERRI）、9项病人健康问卷（PHQ-9）进行调查。采用潜在类别分析识别子宫内膜癌病人创伤后成长类别，采用Logistic回归分析探讨不同类别子宫内膜癌病人创伤后成长的影响因素。

结果

子宫内膜癌病人创伤后成长分为消极应对型、心理平稳型及积极成长型。Logistic回归分析结果显示，体质指数、目的性反刍性沉思水平、抑郁症状是子宫内膜癌病人不同类别创伤后成长的影响因素。

结论

子宫内膜癌病人创伤后成长整体处于中等水平，且存在明显个体差异。临床工作者应依据不同类别特征开展分层干预，以优化病人心理结局。

子宫内膜癌  /  创伤后成长  /  反刍性沉思  /  抑郁  /  潜在类别分析
Objective

To explore the latent classes of post-traumatic growth in patients with endometrial cancer,and to analyze the influencing factors of different categories.

Methods

Convenience sampling method was used to select 263 patients with endometrial cancer hospitalized from June 2022 to June 2024 in our hospital.The General Information Questionnaire,Posttraumatic Growth Inventory(PTGI),Chinese version of Event Related Rumination Inventory(C-ERRI),Patient Health Questionnaire-9(PHQ-9) were used to investigate. Latent class analysis was used to identify categories of post-traumatic growth in patients with endometrial cancer.Logistic regression was used to analyze the influencing factors of posttraumatic growth in patients with different categories of endometrial cancer.

Results

The post-traumatic growth of endometrial cancer were characterized by negative coping,psychological smoothness,and positive growth.Logistic regression analyses results showed that BMI,level of purposeful rumination,and depressive symptoms were the influencing factors of post-traumatic growth in patients with different categories of endometrial cancer.

Conclusions

Clinical staff should carry out stratified interventions based on different category characteristics to optimize patient psychological outcomes.Clinical staff should implement precise management of patients based on the influencing factors of different categories of post-traumatic growth,combine with the specificity of post-traumatic growth patterns,improve mental health outcomes of patients.

endometrial cancer  /  post-traumatic growth  /  rumination  /  depression  /  latent class analysis
董娜, 董仙萍, 刘英杰, 厉昕妤. 子宫内膜癌病人创伤后成长潜在类别分析. 护理研究, 2026 , 40 (11) : 1868 -1874 . DOI: 10.12102/j.issn.1009-6493.2026.11.008
Na DONG, Xianping DONG, Yingjie LIU, Xinyu LI. Latent class analysis of post-traumatic growth in patients with endometrial cancer[J]. Chinese Nursing Research, 2026 , 40 (11) : 1868 -1874 . DOI: 10.12102/j.issn.1009-6493.2026.11.008
正文
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子宫内膜癌（endometrial cancer，EC）是起源于子宫内膜上皮的恶性肿瘤，是女性常见的生殖系统肿瘤。世界卫生组织统计，全球每年新发子宫内膜癌病例已超过40万例，在女性恶性肿瘤中发病率位居第6位[1]。随着诊疗水平的不断提升，多数病人可获得较长生存期，但手术及放化疗等治疗手段常伴随内分泌紊乱、性功能受损等不良反应，使病人在疾病过程中面临显著的心理压力[2]。创伤后成长（post-traumatic growth，PTG）是指个体在经历重大应激事件后，在认知、情感及行为层面产生积极变化的心理过程。既往研究显示，癌症病人在承受负性情绪的同时，也可能出现心理重建与积极适应[3]。反刍性沉思作为一种重要的认知加工方式，可分为侵入性反刍和目的性反刍，其中侵入性反刍多与负性情绪相关，而目的性反刍则可能促进认知整合与心理适应[4]。因此，从个体差异角度探讨创伤后成长的潜在类型，有助于深入理解病人心理反应机制。潜在类别分析（latent class analysis）是一种用于识别和描述样本潜在类别的方法，可根据个体间的异质性将具有相似特征的个体归为同一类别[5]。本研究拟基于潜在类别分析，以创伤后成长为切入点，探讨子宫内膜癌病人创伤后成长的群体异质性，并分析病人创伤后成长与反刍性沉思、抑郁的相关性，以期为子宫内膜癌病人制定有效的护理干预措施提供理论依据。
1　对象与方法
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1.1　研究对象
采用便利抽样法，于2022年6月—2024年6月在我院住院治疗的子宫内膜癌病人为研究对象。纳入标准：1）经病理学确诊为子宫内膜癌；2）年龄≥18岁；3）具备基本沟通与问卷填写能力；4）自愿参与本研究。排除标准：1）合并其他恶性肿瘤或严重躯体疾病；2）既往有精神障碍史；3）调查期间存在明显精神异常或正在接受精神类药物治疗。共发放问卷280份，回收有效问卷263份，有效回收率为93.93%。本研究已通过唐山市妇幼保健院科研项目伦理委员会审查（伦理审查编号：2022-LL-02017）。
1.2　调查工具
1.2.1　一般资料调查表
主要调查子宫内膜癌病人的社会人口学资料和临床资料。社会人口学资料包括年龄、体质指数（body mass index，BMI）、婚姻状况、受教育程度、家庭人均月收入；在病人电子病历中提取临床资料，包括肿瘤复发、病理分化程度、癌症分期和放化疗情况。
1.2.2　创伤后成长量表（Posttraumatic Growth Inventory，PTGI）
该量表由Tedeschi等[6]于1996年编制，旨在评估个体在经历创伤事件后所体验到的积极变化和心理成长。我国学者汪际等[7]于2011年将该量表翻译汉化，修订后的中文版PTGI包括自我改变、人生感悟、新的可能性、与他人关系以及个人力量5个维度，共20个条目，各条目采用Likert 6级评分法计分，其中“完全没有变化”计0分，“有非常明显的变化”计5分，得分越高，表明个体获得的创伤后成长越高。在本研究中，中文版PTGI的Cronbach's α系数为0.911，提示内部一致性良好。
1.2.3　简体中文版事件相关反刍性沉思问卷（Chinese version of Event Related Rumination Inventory，C-ERRI）
源量表由Cann等[8]于2011年编制，我国学者董超群等[9]于2013年对其进行汉化修订。C-ERRI包括侵入性反刍性沉思和目的性反刍性沉思2个维度，共20个条目，各条目采用Likert 4级评分法计分，“从不”计0分，“经常”计3分，总分为0~60分，得分越高代表受试者反刍性沉思水平越高。本研究中该量表2个维度的Cronbach's α系数分别为0.884和0.819。
1.2.4　9项病人健康问卷（Patient Health Questionnaire-9，PHQ-9）
采用Kroenke等[10]研发的PHQ-9评估病人的抑郁水平。该量表共9个条目，各条目采用Likert 4级评分法计分，“完全不会”计0分，“几乎每天”计3分，总分0~27分，得分越高表示个体抑郁水平越高。该量表的Cronbach's α系数为0.815，具有良好的内部一致性。
1.3　统计学方法
采用SPSS 27.0统计学软件对数据进行统计分析，符合正态分布的定量资料以均数±标准差（x±s）表示，定性资料用例数、百分比（%）表示。采用Mplus软件构建潜在类别模型，从类别1开始逐步增加类别数，并综合比较模型拟合指标[赤池信息准则（Akaike information criterion，AIC）、贝叶斯信息准则（Bayesian information criterion，BIC）、经过样本校正的贝叶斯信息准则（sample size-adjusted BIC，aBIC）、熵（Entropy）及似然比检验（Lo-Mendell-Rubin test，LMRT）检验]结果确定最佳模型。一般情况下，AIC、BIC和aBIC越小，表明模型拟合度越好；Entropy取值为0~1，数值越大，表示模型分类准确性越高；LMRT的P<0.05时，该类别模型显著优于上个类别模型。组间差异采用单因素方差分析、χ²检验或Fisher确切概率法。采用Logistic回归模型分析子宫内膜癌病人创伤后成长各类别的影响因素。所有检验均为双侧检验，以P<0.05为差异有统计学意义。
2　结果
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2.1　子宫内膜癌病人的一般资料
共纳入263例子宫内膜癌病人，年龄（55.69±6.61）岁；体质指数为（22.69±3.46）kg/m²；已婚病人243例，占92.4%；受教育程度以初中/高中为主，共121例（46.0%）；家庭人均月收入≤3 000元者132例（50.2%）；肿瘤复发89例（33.8%）；病理分化程度以中分化为主，共153例（58.2%）。
2.2　子宫内膜癌病人创伤后成长、反刍性沉思和抑郁现状及相关性
子宫内膜癌病人PTGI总分为（56.05±12.73）分，自我改变、人生感悟、新的可能性、与他人关系、个人力量各维度得分分别为（8.94±3.29）分、（15.96±4.18）分、（12.30±3.20）分、（9.75±1.99）分、（9.11±1.99）分；病人C-ERRI总分为（30.99±9.05）分，侵入性反刍性沉思维度得分为（9.32±2.07）分，目的性反刍性沉思维度得分为（21.67±4.45）分；PHQ-9得分为（6.34±3.13）分。子宫内膜癌病人创伤后成长、反刍性沉思以及抑郁的相关性分析结果见表1。
2.3　子宫内膜癌病人创伤后成长潜在类别的确定
基于子宫内膜癌病人PTGI的5个维度得分构建潜在类别模型，通过逐步增加类别数比较模型拟合情况。结果显示，类别3模型的AIC、BIC及aBIC相对较低，Entropy为0.853，且LMRT差异有统计学意义（P<0.001），同时各类别具有较好的临床解释性，因此确定类别3模型为最优模型。类别3模型病人样本占比分别为33%、45%和22%；各类别平均后验归属概率（average posterior probability，APP）分别为92.4%、95.7%和93.9%，提示模型分类结果可靠。详见表2。
2.4　不同类别子宫内膜癌病人创伤后成长特征及命名
根据病人PTGI各维度得分区分3个类别。C1组病人呈现较低水平的创伤后成长水平，将该类别命名为消极应对组，共86例病人，占32.7%；C2组创伤后成长处于中等水平，故命名为心理平稳组，共118例，占44.9%；C3组创伤后成长各维度均处于高水平，故命名为积极成长组，共59例，占22.4%。详见图1。
2.5　子宫内膜癌病人创伤后成长潜在类别影响因素的单因素分析
单因素分析结果显示，消极应对组、心理平稳组、积极成长组病人体质指数、婚姻状况、C-ERRI总分、目的性反刍性沉思及PHQ-9得分比较，差异均有统计学意义（均P<0.05），详见表3。
2.6　子宫内膜癌病人创伤后成长潜在类别影响因素的多因素分析
以创伤后成长潜在类别作为因变量，将单因素分析中差异有统计学意义的变量（体质指数、婚姻状况、C-ERRI总分、目的性反刍性沉思得分及PHQ-9得分）作为自变量进行Logistic回归分析，自变量赋值见表4。Logistic回归分析结果显示，以积极成长组为参照，具有较低水平体质指数[OR=0.834，95%CI（0.720，0.966）]、较低水平目的性反刍性沉思[OR=0.537，95%CI（0.461，0.626）]和较高水平的抑郁症状[OR=1.168，95%CI（1.068，1.291）]的病人进入消极应对组的可能性更大；以积极成长组为参照，具有较低水平目的性反刍性沉思[OR=0.679，95%CI（0.600,0.767）]和较高水平的抑郁症状[OR=1.110，95%CI（1.016,1.213）]的病人进入心理平稳组的可能性更大。详见表5。
3　讨论
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3.1　子宫内膜癌病人创伤后成长处于中等水平，且存在群体异质性
本研究结果显示，子宫内膜癌病人PTGI总分为（56.05±12.73）分，自我改变、人生感悟、新的可能性、与他人关系、个人力量5个维度得分均处于中等水平，提示病人在疾病诊疗过程中虽能够在一定程度上体验到积极心理变化，但整体创伤后成长水平仍有较大提升空间。子宫内膜癌病人在确诊、治疗及康复过程中不仅要应对疾病本身带来的威胁，还需面对手术创伤、内分泌改变、性功能受损、复发担忧以及家庭角色调整等多重压力，因此其心理反应往往兼具负性冲击与积极适应的双重特征[11]。这也说明子宫内膜癌病人的心理变化并非单纯表现为焦虑、抑郁等消极反应，而是在痛苦体验与认知重建并存的过程中逐步发展出不同程度的成长体验[12]。提示医护人员在关注病人负性情绪的同时，也应重视其积极心理的激发与培养，以帮助病人完成从疾病应激向积极适应转化。
本研究采用潜在类别分析识别出子宫内膜癌病人3种创伤后成长潜在类别：消极应对组、心理平稳组和积极成长组，分别对应较低、中等和较高水平的创伤后成长。表明子宫内膜癌病人在创伤后成长上并非同质化群体，传统基于均分的分析方式虽然能够反映总体趋势，但可能掩盖不同亚组病人的心理适应差异。值得注意的是，本研究中消极应对组病人并非少数，提示临床实践中仍有相当一部分病人未能在患病经历中形成积极意义建构，其心理调适过程可能停留在情绪困扰、消极归因或被动应对阶段。相比之下，积极成长组病人在多个维度上均表现出较高水平的成长，提示其在疾病冲击后更可能通过认知重塑、意义寻找和自我整合实现积极适应[13]。潜在类别分析所得的分类结果不仅有统计学意义，也有明确的临床分层价值，即不同类别病人的心理风险和干预需求并不相同，后续护理管理不宜采用单一模式，而应依据病人所属亚型实施更有针对性的心理支持与健康教育。上述结果也进一步说明，在子宫内膜癌病人中仅识别心理问题是不够的，更重要的是识别其处于哪一种心理适应轨迹之中，并据此开展分层干预。
3.2　子宫内膜癌病人不同类别创伤后成长的影响因素
本研究结果显示，消极应对组病人主要表现为体质指数相对较低、目的性反刍性沉思较少、抑郁症状较重；心理平稳组与积极成长组相比，也表现出目的性反刍性沉思不足和抑郁症状较明显的特点。提示子宫内膜癌病人创伤后成长水平的高低并非仅由疾病严重程度决定，更可能与病人的身心储备状态及认知加工方式密切相关[14]。从这一角度看，目的性反刍性沉思和抑郁症状并不是附属变量，而可能是区分不同成长亚型的关键心理学特征。
3.2.1　较低水平体质指数的病人更易归入消极应对组
本研究多因素分析结果显示，以积极成长组为参照，体质指数越低的病人越可能进入消极应对组，提示体质指数可能是影响子宫内膜癌病人创伤后成长类别归属的重要因素之一。体质指数在一定程度上反映了病人的营养储备和体能状态。对于肿瘤病人而言，较低体质指数常提示营养状况较差、体力不足、疲乏感较重，病人在应对疾病与治疗所带来的长期压力时，可能缺乏足够的生理基础与心理能量，进而影响其主动应对、意义建构和积极认知加工[15]。创伤后成长并非单纯的心理现象，其形成往往以一定的身体状态和功能水平为基础。当病人长期处于乏力、食欲减退或身体恢复不佳状态时，其注意资源更容易集中于症状负担和现实困扰，而难以进一步发展为积极反思和成长体验[16]。这一结果提示，临床护理不应将体质指数仅视为一般营养指标，而应看到其与病人心理适应之间可能存在的联系。对于体质指数偏低的病人，应尽早开展营养风险筛查和个体化饮食指导，必要时联合营养科给予干预，同时关注其疲乏、睡眠、活动耐力等相关问题，帮助病人逐步恢复身体功能[14]。随着身体状态的改善，病人参与疾病管理、信息获取和积极思考的能力也可能相应增强。黄彩妹等[17]研究指出，较好的身心状态有助于病人形成更高水平的创伤后成长；王瑞瑞等[18]对糖尿病足截肢病人的研究也发现，体质指数异常会影响创伤后成长水平。尽管体质指数对不同疾病人群的作用方向和具体机制可能存在差异，但这些研究均提示，身体状态与积极心理适应之间存在密切关联。未来研究可进一步结合营养指标、疲乏水平及体力活动状况，探讨体质指数影响创伤后成长的潜在路径。
3.2.2　目的性反刍性沉思不足和抑郁症状较重的病人更难进入积极成长状态
本研究结果表明，以积极成长组为参照，无论是消极应对组还是心理平稳组，子宫内膜癌病人的目的性反刍性沉思水平均更低，而抑郁症状均更严重。这一结果提示，目的性反刍性沉思和抑郁症状不仅与创伤后成长相关，而且可能在病人由中低水平适应走向积极成长过程中发挥关键作用[19]。
目的性反刍性沉思是一种相对积极的认知加工方式，强调个体在经历创伤事件后，主动对事件意义、自我变化及未来生活进行持续思考和整合[20]。与侵入性反刍更多体现被动、反复且难以控制的负性思维不同，目的性反刍更接近一种带有方向性的认知重建。目的性反刍属于积极的认知加工方式，有助于个体对疾病经历进行意义建构，从而促进心理适应与成长[21]。本研究中积极成长组病人目的性反刍性沉思得分最高，说明较高水平的创伤后成长往往不是自然发生的，而是建立在病人主动思考、反复整合疾病经历并逐渐重构生命意义的基础之上。姚玲玉等[22]研究发现，自我管理效能可能介导了反刍性沉思对于创伤后成长的影响。李婷等[23]研究发现，心理弹性在反刍性沉思与创伤后成长中起中介作用。这提示目的性反刍并不是孤立发生的心理过程，可通过提升病人的控制感、自我效能和心理韧性进一步促进其创伤后成长。从临床实践角度看，这一结果提示护理干预不能仅停留在安慰病人情绪层面，还应帮助病人进行积极、结构化的认知加工。例如可通过疾病教育、叙事护理、同伴支持、小组分享及基于问题解决的心理辅导，引导病人表达患病后的真实体验，思考疾病对生活观念、人际关系和自我认知带来的变化，并逐步将被动承受疾病转化为主动理解和重建经历[24]。同时，可借助微信平台、短视频科普、康复案例分享等形式，提高病人对疾病治疗前景和康复路径的认识，帮助其增强可控感和希望感，从而为积极成长创造条件[25]。
此外，本研究发现抑郁水平越高，病人越可能归入消极应对组或心理平稳组，而较难进入积极成长组。这一结果与既往研究结果[26]基本一致。抑郁情绪常伴消极归因、自我否定、无助感增加及对未来预期悲观，这些特征会削弱病人对疾病经历进行积极整合的能力，而难以进一步完成意义建构和积极适应[27]。值得注意的是，本研究中抑郁病人不仅易归于消极应对组，也易归于心理平稳组，这提示心理平稳可能并不等同于真正意义上的积极成长。部分病人虽然未表现出极端负性应对，但其心理状态仍可能处于勉强维持或低水平适应阶段，尚未实现更深层次的认知转化。由此可见，抑郁症状可能是限制病人从一般适应走向积极成长的重要阻碍因素[28]。因此，临床护理中应重视对子宫内膜癌病人抑郁症状的早期筛查和持续评估，尤其是对处于术后恢复期、治疗副作用明显或对预后担忧较重的病人，应及时识别其情绪风险。对于抑郁症状较明显者，除常规心理支持外，还可联合心理科开展针对性干预，如认知行为指导、情绪疏导、放松训练及家庭支持强化等，以减轻病人负性情绪[29-30]。在此基础上，进一步引导病人开展积极认知加工，才更有可能真正地促进其创伤后成长。
4　小结
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本研究通过潜在类别分析识别出子宫内膜癌病人创伤后成长的3个潜在类别：消极应对型、心理平稳型和积极成长型，发现体质指数、目的性反刍性沉思水平、抑郁症状是影响病人创伤后成长潜在类别的重要影响因素。建议临床基于不同类别病人心理特征实施分层管理策略，以提升病人整体心理适应水平。本研究存在一定的局限性：首先，研究对象仅来自1所医院，受地区和经济等的影响，结果的可推广性还需谨慎对待。此外，本研究为横断面设计，只可确定各个变量间的关联作用，无法进行因果判断，因此还需开展纵向研究以进一步验证。最后，本研究纳入的数据多来自病人主观性自我报告，实验室指标等客观数据不足，因此还需结合特异性生物学指标进一步测试。

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2026年第40卷第11期
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doi: 10.12102/j.issn.1009-6493.2026.11.008
  • 接收时间：2025-09-28
  • 首发时间：2026-10-30
  • 出版时间：2026-06-10
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  • 收稿日期：2025-09-28
  • 修回日期：2026-04-25
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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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