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Article(id=1241522928433550135, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202205009, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1682870400000, receivedDateStr=2023-05-01, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773931732519, onlineDateStr=2026-03-19, pubDate=1710000000000, pubDateStr=2024-03-10, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773931732519, onlineIssueDateStr=2026-03-19, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773931732519, creator=13701087609, updateTime=1773931732519, updator=13701087609, issue=Issue{id=1241522919977841545, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='5', pageStart='769', pageEnd='960', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773931730503, creator=13701087609, updateTime=1773931880386, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1241523548695622547, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1241523548695622548, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1241522919977841545, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=937, endPage=942, ext={EN=ArticleExt(id=1241522928878146388, articleId=1241522928433550135, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between symptom interference and cancer-related fatigue in cancer patients undergoing radiotherapy and chemotherapy: mediation and regulation of stress resistance, columnId=1228016569138213037, journalTitle=Modern Preventive Medicine, columnName=Clinical Medicine and Prevention, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the relationship between stress resistance, symptom interference, and cancer-related fatigue in cancer patients undergoing radiotherapy and chemotherapy.

Methods

A total of 336 cancer patients undergoing radiotherapy and chemotherapy in the First Affiliated Hospital of Hebei North University from October 2020 to October 2021 were selected by convenient sampling. The related data were collected by general condition questionnaire, cancer fatigue scale (CFS), Chinese version memory symptom assessment scale (MSAS-Ch), and stress resistance scale (CD-RICS).

Results

The scores of cancer-related fatigues, stress resistance, and symptom disturbance were 30.55 ±8.26, 62.14 ±14.04, and 1.11 ±0.38, respectively. The level of stress resistance played an intermediary role in symptom interference and cancer-related fatigue, accounting for 26.26% of the total effect. The level of stress resistance had a regulatory effect between symptom interference and cancer-related fatigue (β = 0.102, ΔR2=0.382, P < 0.05).

Conclusion

The level of stress resistance plays a mediating effect and regulation between symptom interference and cancer-related fatigue. Encouraging patients to strengthen the level of stress resistance, strengthen positive psychological construction, and weaken the level of symptom interference is helpful to reduce cancer-related fatigue.

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目的

分析癌症放化疗患者抗逆力水平、症状干扰与癌因性疲乏之间的关系。

方法

采用便利抽样法选取2020年10月—2021年10月在河北北方学院附属第一医院的336名癌症放化疗患者为研究对象。采用一般情况调查表、癌症疲乏量表（CFS）、中文版记忆症状评估量表（MSAS-Ch）和抗逆力量表（CD-RICS）收集相关资料。

结果

癌症放化疗患者癌因性疲乏得分为（30.55±8.26）分，抗逆力水平得分为（62.14±14.04）分，症状干扰得分为（1.11±0.38）分；抗逆力水平在症状干扰与癌因性疲乏中起到中介作用，中介效应值占总效应值的26.26%；抗逆力水平在症状干扰与癌因性疲乏间起调节效应（β=0.102，△R2=0.382，P<0.05）。

结论

抗逆力水平在症状干扰与癌因性疲乏间起中介效应与调节相应，鼓励患者加强抗逆力水平，强化积极心理建设，弱化症状干扰水平，有助于降低患者癌因性疲乏。

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赵雅宁，E-mail:
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许丽雅（1994—），女，硕士，讲师，研究方向：神经康复学，心理康复学

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许丽雅（1994—），女，硕士，讲师，研究方向：神经康复学，心理康复学

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许丽雅（1994—），女，硕士，讲师，研究方向：神经康复学，心理康复学

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Journal of Nursing Science, 2013, 28(6): 72-75., articleTitle=Correlationships between symptom distress, and anxiety and depression in esophageal cancer patients undergoing chemotherapy after radical esophagectomy, refAbstract=null)], funds=[Fund(id=1241678324968247813, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, awardId=HB17RK004, language=CN, fundingSource=河北省社会科学基金(HB17RK004), fundOrder=null, country=null), Fund(id=1241678325333152267, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, awardId=20210301147, language=CN, fundingSource=河北省社会科学发展研究课题(20210301147), fundOrder=null, country=null), Fund(id=1241678326218150417, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, awardId=20231582, language=CN, fundingSource=河北省卫生健康委医学科学研究课题(20231582), fundOrder=null, country=null)], companyList=[AuthorCompany(id=1241678293397721221, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, xref=null, ext=[AuthorCompanyExt(id=1241678293406109830, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, companyId=1241678293397721221, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=School of Nursing and Rehabilitation, North China University of Technology, Tangshan, Hebei 063210, China), AuthorCompanyExt(id=1241678293410304136, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, companyId=1241678293397721221, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=华北理工大学护理与康复学院，河北 唐山 063210)])], figs=[ArticleFig(id=1241678317158453650, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=EN, label=Figure 1, caption=Pathway analysis model of symptom interference, stress resistance level, and cancer-related fatigue in patients with cancer chemoradiotherapy, figureFileSmall=wmHZEWRtEZtUfY8dtlAkSQ==, figureFileBig=Hsqrdo7thZ7m2EkbgZyGZw==, tableContent=null), ArticleFig(id=1241678319578567070, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=CN, label=图1, caption=癌症放化疗患者症状干扰、抗逆力水平、癌因性疲乏的路径分析模型, figureFileSmall=wmHZEWRtEZtUfY8dtlAkSQ==, figureFileBig=Hsqrdo7thZ7m2EkbgZyGZw==, tableContent=null), ArticleFig(id=1241678319926694313, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=EN, label=Table 1, caption=

Univariate analysis of general demographic data and cancer-related fatigue in cancer patients undergoing radiotherapy and chemotherapy（n=336）

, figureFileSmall=null, figureFileBig=null, tableContent=
因素分类例数（%）CRF（）F/t值P值
性别男130（38.7）28.44±7.70-3.879<0.001
女206（61.3）31.95±8.32
年龄（岁）<4527（8.0）27.78±9.9412.132<0.001
45～60167（49.7）28.93±8.40
≥60142（42.3）33.08±7.05
文化程度小学及以下64（19.0）32.66±8.172.4950.084
中学199（59.2）30.12±7.89
大专及以上73（21.7）30.07±8.88
家庭人均月收入（元）<2 000131（39.0）32.24±7.393.1060.027
2 000～2 99978（23.2）29.74±8.79
3 000～4 99994（28.0）20.10±9.02
≥5 00033（9.8）30.33±7.04
婚姻状况已婚278（82.7）30.97±8.453.6560.013
未婚23（6.8）25.43±5.12
离异12（3.6）29.00±7.93
丧偶23（6.8）32.04±6.96
肿瘤部位头颈部肿瘤143（42.6）31.62±7.674.4930.016
妇科肿瘤75（22.3）30.23±7.95
胸部肿瘤25（7.4）25.96±7.64
消化道肿瘤93（27.7）30.55±9.15
癌症分期I期20（6.0）26.70±5.953.4650.017
II期137（40.8）31.04±8.34
III期118（35.1）29.66±8.14
IV期61（18.2）32.66±8.41
患病年限（年）<1250（74.4）31.02±8.031.5970.204
1～574（22.0）29.08±9.33
>512（3.6）31.08±4.14
是否转移是91（27.1）32.12±8.542.0790.038
否245（72.9）30.02±9.09
是否手术是77（22.9）33.01±8.93-0.7010.484
否259（77.1）30.76±8.05
), ArticleFig(id=1241678320333541807, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=CN, label=表1, caption=

癌症放化疗患者一般人口学资料与癌因性疲乏的单因素分析（n=336）

, figureFileSmall=null, figureFileBig=null, tableContent=
因素分类例数（%）CRF（）F/t值P值
性别男130（38.7）28.44±7.70-3.879<0.001
女206（61.3）31.95±8.32
年龄（岁）<4527（8.0）27.78±9.9412.132<0.001
45～60167（49.7）28.93±8.40
≥60142（42.3）33.08±7.05
文化程度小学及以下64（19.0）32.66±8.172.4950.084
中学199（59.2）30.12±7.89
大专及以上73（21.7）30.07±8.88
家庭人均月收入（元）<2 000131（39.0）32.24±7.393.1060.027
2 000～2 99978（23.2）29.74±8.79
3 000～4 99994（28.0）20.10±9.02
≥5 00033（9.8）30.33±7.04
婚姻状况已婚278（82.7）30.97±8.453.6560.013
未婚23（6.8）25.43±5.12
离异12（3.6）29.00±7.93
丧偶23（6.8）32.04±6.96
肿瘤部位头颈部肿瘤143（42.6）31.62±7.674.4930.016
妇科肿瘤75（22.3）30.23±7.95
胸部肿瘤25（7.4）25.96±7.64
消化道肿瘤93（27.7）30.55±9.15
癌症分期I期20（6.0）26.70±5.953.4650.017
II期137（40.8）31.04±8.34
III期118（35.1）29.66±8.14
IV期61（18.2）32.66±8.41
患病年限（年）<1250（74.4）31.02±8.031.5970.204
1～574（22.0）29.08±9.33
>512（3.6）31.08±4.14
是否转移是91（27.1）32.12±8.542.0790.038
否245（72.9）30.02±9.09
是否手术是77（22.9）33.01±8.93-0.7010.484
否259（77.1）30.76±8.05
), ArticleFig(id=1241678320790720948, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=EN, label=Table 2, caption=

Correlation between symptom distress, psychological resilience, and cancer-related fatigue (n=336)

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变量癌因性疲乏症状干扰抗逆力水平
癌因性疲乏1.0000.179*-0.295*
症状干扰0.179*1.000-0.172*
抗逆力水平-0.295*-0.172*1.000
), ArticleFig(id=1241678321566667200, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=CN, label=表2, caption=

症状干扰、抗逆力水平与癌因性疲乏的相关性(n=336，r)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量癌因性疲乏症状干扰抗逆力水平
癌因性疲乏1.0000.179*-0.295*
症状干扰0.179*1.000-0.172*
抗逆力水平-0.295*-0.172*1.000
), ArticleFig(id=1241678321977708996, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=EN, label=Table 3, caption=

Regression analysis of symptom distress and psychological resilience on cancer-related fatigue of cancer patients undergoing radiotherapy and chemotherapy (n=336)

, figureFileSmall=null, figureFileBig=null, tableContent=
变量癌因性疲乏抗逆力水平癌因性疲乏
Bt值P值Bt值P值Bt值P值
症状干扰4.0783.2760.001-6.698-3.1510.0023.0072.4700.014
抗逆力水平-0.160-5.1080.000
性别3.1112.8120.005-3.223-1.7060.0892.5952.4240.016
年龄2.6523.4670.001-2.819-2.1590.0322.2012.9660.003
家庭人均月收入0.158-0.3350.7382.1362.6570.0080.1840.4010.689
婚姻状况-0.320-0.6270.5310.0570.0650.948-0.311-0.6320.528
肿瘤部位-0.4140.342-0.165-0.2230.824-0.440-1.0510.294
癌症分期-0.506-0.7730.440-1.337-1.1960.233-0.720-1.1390.256
是否转移-3.119-2.3830.0182.3931.0710.285-2.736-2.1660.031
F值8.1817.71910.733
R2值0.1680.1600.230
P值0.0000.0000.000
), ArticleFig(id=1241678322409722319, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=CN, label=表3, caption=

症状干扰和抗逆力水平对癌症放化疗患者癌因性疲乏的回归分析（n=336）

, figureFileSmall=null, figureFileBig=null, tableContent=
变量癌因性疲乏抗逆力水平癌因性疲乏
Bt值P值Bt值P值Bt值P值
症状干扰4.0783.2760.001-6.698-3.1510.0023.0072.4700.014
抗逆力水平-0.160-5.1080.000
性别3.1112.8120.005-3.223-1.7060.0892.5952.4240.016
年龄2.6523.4670.001-2.819-2.1590.0322.2012.9660.003
家庭人均月收入0.158-0.3350.7382.1362.6570.0080.1840.4010.689
婚姻状况-0.320-0.6270.5310.0570.0650.948-0.311-0.6320.528
肿瘤部位-0.4140.342-0.165-0.2230.824-0.440-1.0510.294
癌症分期-0.506-0.7730.440-1.337-1.1960.233-0.720-1.1390.256
是否转移-3.119-2.3830.0182.3931.0710.285-2.736-2.1660.031
F值8.1817.71910.733
R2值0.1680.1600.230
P值0.0000.0000.000
), ArticleFig(id=1241678323043062231, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=EN, label=Table 4, caption=

Mediating effect test of psychological resilience

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类别效应值（95%CI）Boot标准误效应占比（%）
总效应4.078（1.629～6.528）1.245
直接效应3.007（0.612～5.403）1.21873.73
间接效应1.071（0.283～2.112）0.46226.26
), ArticleFig(id=1241678323307303387, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=CN, label=表4, caption=

抗逆力水平的中介效应检验

, figureFileSmall=null, figureFileBig=null, tableContent=
类别效应值（95%CI）Boot标准误效应占比（%）
总效应4.078（1.629～6.528）1.245
直接效应3.007（0.612～5.403）1.21873.73
间接效应1.071（0.283～2.112）0.46226.26
), ArticleFig(id=1241678323823202787, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=EN, label=Table 5, caption=

Linear regression analysis of adjustment effect of psychological resilience

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类别模型1模型2
βP值βP值
症状干扰0.323<0.0010.325<0.001
抗逆力水平-0.235<0.001-0.231<0.001
症状干扰×抗逆力水平——0.1020.022
R2值0.3870.396
△R2值0.3740.382
F值29.54126.854
), ArticleFig(id=1241678324418793966, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1241522928433550135, language=CN, label=表5, caption=

抗逆力水平调节效应线性回归分析

, figureFileSmall=null, figureFileBig=null, tableContent=
类别模型1模型2
βP值βP值
症状干扰0.323<0.0010.325<0.001
抗逆力水平-0.235<0.001-0.231<0.001
症状干扰×抗逆力水平——0.1020.022
R2值0.3870.396
△R2值0.3740.382
F值29.54126.854
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癌症放化疗患者症状干扰与癌因性疲乏的关系——抗逆力水平的中介和调节作用
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许丽雅 , 刘瑶 , 韩影 , 齐丽娜 , 赵雅宁
现代预防医学 | 临床与预防 2024,51(5): 937-942
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现代预防医学 | 临床与预防 2024, 51(5): 937-942
癌症放化疗患者症状干扰与癌因性疲乏的关系——抗逆力水平的中介和调节作用
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许丽雅, 刘瑶, 韩影, 齐丽娜, 赵雅宁
作者信息
  • 华北理工大学护理与康复学院，河北 唐山 063210

    • 许丽雅（1994—），女，硕士，讲师，研究方向：神经康复学，心理康复学

通讯作者:

赵雅宁，E-mail:
Relationship between symptom interference and cancer-related fatigue in cancer patients undergoing radiotherapy and chemotherapy: mediation and regulation of stress resistance
Li-ya XU, Yao LIU, Ying HAN, Li-na QI, Ya-ning ZHAO
Affiliations
  • School of Nursing and Rehabilitation, North China University of Technology, Tangshan, Hebei 063210, China
出版时间: 2024-03-10 doi: 10.20043/j.cnki.MPM.202205009
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摘要
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目的

分析癌症放化疗患者抗逆力水平、症状干扰与癌因性疲乏之间的关系。

方法

采用便利抽样法选取2020年10月—2021年10月在河北北方学院附属第一医院的336名癌症放化疗患者为研究对象。采用一般情况调查表、癌症疲乏量表（CFS）、中文版记忆症状评估量表（MSAS-Ch）和抗逆力量表（CD-RICS）收集相关资料。

结果

癌症放化疗患者癌因性疲乏得分为（30.55±8.26）分，抗逆力水平得分为（62.14±14.04）分，症状干扰得分为（1.11±0.38）分；抗逆力水平在症状干扰与癌因性疲乏中起到中介作用，中介效应值占总效应值的26.26%；抗逆力水平在症状干扰与癌因性疲乏间起调节效应（β=0.102，△R2=0.382，P<0.05）。

结论

抗逆力水平在症状干扰与癌因性疲乏间起中介效应与调节相应，鼓励患者加强抗逆力水平，强化积极心理建设，弱化症状干扰水平，有助于降低患者癌因性疲乏。

抗逆力水平  /  症状干扰  /  癌因性疲乏
Objective

To analyze the relationship between stress resistance, symptom interference, and cancer-related fatigue in cancer patients undergoing radiotherapy and chemotherapy.

Methods

A total of 336 cancer patients undergoing radiotherapy and chemotherapy in the First Affiliated Hospital of Hebei North University from October 2020 to October 2021 were selected by convenient sampling. The related data were collected by general condition questionnaire, cancer fatigue scale (CFS), Chinese version memory symptom assessment scale (MSAS-Ch), and stress resistance scale (CD-RICS).

Results

The scores of cancer-related fatigues, stress resistance, and symptom disturbance were 30.55 ±8.26, 62.14 ±14.04, and 1.11 ±0.38, respectively. The level of stress resistance played an intermediary role in symptom interference and cancer-related fatigue, accounting for 26.26% of the total effect. The level of stress resistance had a regulatory effect between symptom interference and cancer-related fatigue (β = 0.102, ΔR2=0.382, P < 0.05).

Conclusion

The level of stress resistance plays a mediating effect and regulation between symptom interference and cancer-related fatigue. Encouraging patients to strengthen the level of stress resistance, strengthen positive psychological construction, and weaken the level of symptom interference is helpful to reduce cancer-related fatigue.

Stress resistance level  /  Symptom interference  /  Cancer-related fatigue
许丽雅, 刘瑶, 韩影, 齐丽娜, 赵雅宁. 癌症放化疗患者症状干扰与癌因性疲乏的关系——抗逆力水平的中介和调节作用. 现代预防医学, 2024 , 51 (5) : 937 -942 . DOI: 10.20043/j.cnki.MPM.202205009
Li-ya XU, Yao LIU, Ying HAN, Li-na QI, Ya-ning ZHAO. Relationship between symptom interference and cancer-related fatigue in cancer patients undergoing radiotherapy and chemotherapy: mediation and regulation of stress resistance[J]. Modern Preventive Medicine, 2024 , 51 (5) : 937 -942 . DOI: 10.20043/j.cnki.MPM.202205009
正文
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我国癌症的发病率较高，每年新发癌症患者人数达457万，占比全球新发人数的23.7%[1]。而针对癌症的治疗，放化疗仍作为重要的方法之一。但放疗与化疗治疗周期长，在提高患者生存率的同时，其治疗的毒性反应也会对患者的躯体与精神造成不良的影响。癌因性疲乏是癌症放化疗患者最常出现的症状之一[2]，并让患者饱受痛苦。研究表明60%以上的癌症放化疗患者出现不同程度的癌因性疲乏症状[3]，而导致患者躯体功能下降，心理压力负担增加，严重时可导致患者治疗的中断[4]。
患者癌因性疲乏与多种因素相关，症状干扰水平是其中重要因素之一。症状干扰是患者由于疾病本身或治疗过程中出现的其他不良症状产生的主观消极心理感受[5]。研究表明，高达98%的癌症患者在治疗的不同阶段尤其是治疗期间均会存在不同程度的症状干扰[6]，且症状干扰对癌因性疲乏影响呈现正相关[7]。此外，抗逆力水平作为积极调节因素，可以提高个体在逆境中的适应性，与癌因性疲乏呈负相关[8]。依据压力与应对模式，本研究旨在探讨抗逆力水平在症状干扰与癌因性疲乏之间的中介与调节作用，为更好的针对性预防与和治疗癌因性疲乏提供参考。
1　对象与方法
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1.1　研究对象
2020年10月—2021年10月在河北北方学院附属第一医院行放化疗治疗的癌症患者为调查对象。纳入标准：（1）年龄不小于18周岁；（2）经临床诊断为癌症，且同时行放疗、化疗或放化疗患者；（3）接受标准的治疗疗程，并能够全周期完成；（4）意识清楚且能配合本研究调查；（5）了解研究目的且自愿参加者。排除标准：（1）有严重躯体与精神功能障碍的患者；（2）意识不清或认知功能无法达到配合调查的患者。本研究经华北理工大学伦理委员会审核，伦理审查号：（2021062），研究对象均签署知情同意书。
1.2　调查工具
1.2.1　癌症放化疗患者一般情况调查表
内容包括性别、年龄、文化程度、家庭人均月收入等。
1.2.2　癌症疲乏量表（cancer fatigue scale,CFS）
由Okuyama[9]等根据癌症病人疲乏症状设计，共15个条目。本研究选择癌症患者放化疗疗程结束出院当天调查患者癌因性疲乏得分情况。量表采用Likert 5级评分法，总分越高，代表患者癌因性疲乏越严重，其中0～5分为无疲乏，6～15分为轻度疲乏，16～30分为重度疲乏，30～60分为重度疲乏。该量表Cronbachα系数为0.63～0.86，重测信度为0.55～0.77，信度较为良好。
1.2.3　中文版记忆症状评估量表(the Chinese version memorial symptom assessment scale，MSAS-Ch)
由Portenoy RK等人[10]编制，Cheng等[11]进行汉化的中文版量表。该量表共32个条目，其中频繁程度采用Likert 4级评分法；严重程度采用Likert 4级评分进行评价，1分代表轻度，4代表很严重；困扰程度采用Likert 5级评分进行评价，0分代表完全没有，4代表很多，总分为各症状的均分。该量表Cronbachα系数为0.79～0.87，结构效度为0.68～0.79，内容效度为0.94，信效度良好。
1.2.4　抗逆力量表(connor-davidson scale, CD-RICS)
该量表采用我国学者译制版本[12]，共25个条目。量表采用Likert 5级评分法，得分越高表示抗逆力水平越高，量表Cronbach α系数为0.91，重测信度为0.76，具有良好的信度。
1.3　统计学方法
采用SPSS 17.0进行数据统计分析，其中采用（均数±标准差）对数据进行描述分析，t检验或方差分析癌因性疲乏的单因素分析，Pearson分析法检验癌因性疲乏、症状干扰与抗逆力水平的相关性，采用多元线性回归法对中介效应进行分析，使用Process插件3.4进行中介、调节模型的检验，检验水准α=0.05。
2　结果
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2.1　共同方法偏差检验
共同方法偏差验证采用Harman单因素法。结果显示，特征值大于1的主成分有28个，第一个主成分解释17.05%的变异量，低于40%临界标准。
2.2　癌症放化疗患者癌因性疲乏的单因素分析
本次共调查癌症放化疗患者340例，有效问卷336人，问卷有效率98.82%。一般资料及单因素分析见表1。
2.3　癌症放化疗患者症状干扰、抗逆力水平与癌因性疲乏的相关性分析
本研究中为癌因性疲乏得分(30.55±8.26)分，抗逆力水平得分为(62.14±14.04)分，症状干扰得分为(1.11±0.38)分。将性别、年龄、婚姻状况、家庭人均月收入、肿瘤部位等作为控制变量，进行偏相关分析。见表2。
2.4　抗逆力水平在癌症放化疗患者癌因性疲乏与症状干扰的中介效用分析
2.4.1　抗逆力水平在癌症放化疗患者癌因性疲乏与症状干扰的中介效用分析
为了进一步研究癌因性疲乏、症状干扰与抗逆力水平之间的关系，以人口学特征作为控制变量，症状干扰作为自变量，抗逆力水平作为中介变量，癌因性疲乏作为因变量进行线性回归分析。结果显示，控制人口学特征后，症状干扰对癌因性疲乏和抗逆力水平均有影响（t=3.276，-3.151；P<0.01）。引入抗逆力水平变量后，症状干扰抗逆力水平（t=2.470，5.108；P<0.05）对癌因性疲乏均有影响，且症状干扰的偏回归系数由4.078降到3.007，说明抗逆力水平在症状干扰与癌因性疲乏间起中介作用。症状干扰对癌因性疲乏的总效应值为4.078，直接效应值为3.007，抗逆力水平对癌因性疲乏的中介效应值为1.071。见表3、图1。
2.4.2　抗逆力水平的Booststrap中介效应检验
偏差校正的Bootstrap检验进一步表明，抗逆力水平的中介效应显著，间接效应值为1.071，置信区间不包含0，中介效应占总效应的比例为26.26%。见表4。
2.5　脑瘤放化疗患者的抗逆力水平调节效应分析
采用多元线性分层回归分析检测抗逆力水平的调节效应。第一层纳入变量症状干扰与抗逆力水平，第二层引入“症状干扰×抗逆力水平”交互项。结果显示，症状干扰（β=0.323，P<0.001）和抗逆力水平（β=0.235，P<0.001）均能影响癌因性疲乏。“症状干扰×抗逆力水平”也具有显著预测作用（β=0.102，P<0.05），说明抗逆力水平在症状干扰与癌因性疲乏间具有调节效应。见表5。
3　讨论
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本研究结果显示癌症放化疗患者癌因性疲乏得分为（30.55±8.26）分,高于常模（18.1±9.4）分[9]。从应激的角度来看，癌症疾病本身作为一个应激源，使患者长期经历恶性的身心刺激，从而导致患者躯体和精力被大量消耗而致疲乏[13]。除此之外，癌因性疲乏与放化疗所引起的副作用有一定关系，如呕吐、疼痛、脱发、失眠、食欲减退等。这些副作用一方面可导致患者机体大量的损耗身体能量，同时降低患者机体对外在能量的摄入欲望值，进而导致患者易发生疲乏感。本研究结果表明，不同性别、年龄、婚姻状况、家庭人均月收入、肿瘤部位、癌症分期、是否转移的癌因性疲乏的得分有统计学意义。与张建萍[14]的研究结果一致。
本研究结果显示，癌症放化疗患者症状干扰水平与癌因性疲乏呈正相关，与国内学者结果一致[15-16]。患者存在的不良反应越多，越易使身体机能状态处于一种疲劳、衰弱的一种消极状态，患者社会参与度的减退，导致患者进入恶性循环状态，加重病态感。与此同时，患者对于疾病的认知模糊，会长期处于对疾病的担忧状态，都会造成患者癌因性疲乏程度加重。因此，了解癌症放化疗患者症状干扰对癌因性疲乏的影响机制，为后期制定针对性的干预措施，提高患者康复效果具有重要意义。
本研究发现，抗逆力水平在症状干扰与癌因性疲乏之间存在部分中介作用。抗逆力水平负性相关癌因性疲乏，与国内外研究学者结果一致[17-19]。拉扎勒斯压力与应对模型指出，个体面对压力源，会进行自我效能的认知评价，自我效能通过对个体期待值、态度及思维方式等方面的影响调控心理应对水平，并对应对行为方式产生影响。研究表明[20]，高症状干扰水平会降低自我效能感，通过加大对压力性事件的危险性评价，增加痛苦感，提高心理脆性，导致患者抗逆力水平降低。患者没办法采取最积极的应对方式处理疾病带来的躯体和精神困扰，自身压力得不到释放，加重了癌因性疲乏感。除此之外，随着放化疗次数的不断增加，患者机体大量正常细胞被破坏，导致患者出现睡眠障碍、呕吐、疼痛等症状，由于长期遭受疾病及不良反应的折磨，身体机能退化，不良情绪加剧，对疾病治疗的希望水平及抗逆力水平降低，患者的适应与应变能力变差，进一步导致导致患者癌因性疲乏程度加重。同时研究表明，高抗逆力水平可减轻放化疗患者的睡眠不良[21]、躯体疼痛[22]等症状，也进一步缓解患者因消极症状导致的癌因性疲乏。
本研究发现，症状干扰水平越高，癌因性疲乏越严重，而抗逆力水平可以调节症状干扰与癌因性疲乏。人体外在消极情绪作为一种应激源长期刺激机体，会产生一种非特异性应急反应，通过神经-内分泌-免疫轴的左右，使机体免疫监视功能下降，体内T淋巴细胞减少，进而影响机体的免疫技能及大量不良反应的出现[23]。而高抗逆力水，可有效的减少上述反应机制的出现，提高患者面对疾病治疗期间的免疫机制，帮助患者建立乐观、自尊、积极的态度，促进有效的应对能力、稳定的情绪等，因此患者可灵活的改变心理与生理的反应，以成功的应对不断变化的内外在环境，进而影响患者的疲乏程度。同时高抗逆力水平的患者个体能够有效的激活和调动自身的心理社会资源的利用，如自尊、乐观、灵活应变能力、稳定的情绪等，有助于自身调节放化疗带来的消极影响，进而进一步降低癌因性疲乏程度。
综上所述，癌症放化疗患者癌因性疲乏症状显著，抗逆力水平在症状干扰与癌因性疲乏间起中介效应与调节效应。鼓励癌症放化疗患者提升抗逆力水平，调整积极心态，降低疲乏感，对后期康复治疗起到重要作用。
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  • 河北省社会科学基金(HB17RK004)
  • 河北省社会科学发展研究课题(20210301147)
  • 河北省卫生健康委医学科学研究课题(20231582)
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2024年第51卷第5期
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doi: 10.20043/j.cnki.MPM.202205009
  • 接收时间：2023-05-01
  • 首发时间：2026-03-19
  • 出版时间：2024-03-10
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  • 收稿日期：2023-05-01
基金
河北省社会科学基金(HB17RK004)
河北省社会科学发展研究课题(20210301147)
河北省卫生健康委医学科学研究课题(20231582)
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    华北理工大学护理与康复学院，河北 唐山 063210

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鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
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