放射性脑损伤鼻咽癌患者心理状况和生存质量的配对病例对照研究

摘要

Objective: To evaluate the effect of radiation-induced brain injury (RIBI) on the psychology and quality of life ( QOL) of nasopharyngeal carcinoma (NPC) patients after radiotherapy. Methods: Psychological assessment was conducted on 46 NPC patients with RIBI ( case group ) and in another 46 NPC patients without RIBI ( control group ) using the Symptom Check List 90 ( SCL-90 ). The QOL was evaluated in the two groups using the World Health Organization QOL BREF questionnaire ( WHOQOL-BREF ). The different scores for SCL-90 and WHOQOL-BREF in the two groups and the risk factors of the two rating scales were also investigated. Results: No significant difference was found in age, gender, educational background, radiation dosage, and post-radiation interval between the RIBI and non-RIBI groups (P＞ 0.05 ). Compared with the control group, patients with RIBI obtained significantly higher scores in the four factors of SCL-90, I.e., interpersonal, anxiety, and depression, among others (sleep and diet). Significant differences were found between the two groups (P＜ 0.001 ). Nevertheless, the patients with RIBI obtained significantly lower score in the WHOQOL-BREF compared with the control group in terms of physical and psychological health, as well as interpersonal relationships, with statistically significant differences (P＜ 0.001). Gender, age, and educational background were not correlated with the psychological disorder and QOL of patients with RIBI ( P ＞ 0.05 ). The scores for SCL-90 negatively correlated with that for the WHOQOL-BREF ( Pearson's correlation, P = 0.009 ). Conclnsion: NPC patients with RIBI exhibit negative emotions and poor QOL. Moreover, negative emotions, such as anxiety and depression, worsen the QOL of NPC patients with RIBI.%目的:探讨鼻咽癌放疗后放射性脑损伤对患者心理状况和生存质量的影响.方法:采用简明心理状况测定90项(SCL-90)和世界卫生组织生存质量测定量表简表(WHOQOL-BREF)对46例鼻咽癌放疗后放射性脑损伤患者(病例组)和46例匹配的非放射性脑损伤者(对照组)进行评定,分析两组心理状况和生存质量的差异及其影响因素.结果:两组在年龄、性别、教育程度、放疗后年限、放疗剂量方面差异均无统计学意义(P>0.05).放射性脑损伤患者在SCL-90的人际关系、抑郁、焦虑、其他(睡眠、饮食)这4个因子的得分均高于对照组,差异有统计学意义(P<0.001);而在WHOQOL–BREF的生理、心理、人际关系3个领域评分低于对照组,差异有统计学意义(P<0.001).SCL-90总分与WHOQOL-BREF量表的心理领域得分呈负相关(Pearson相关因素分析,P=0.009).结论:放射性脑损伤不但可引起焦虑、抑郁等心理障碍而且对生存质量也产生较大的负性影响.