初诊鼻咽癌病人抑郁状态的相关因素研究

目的 探讨初诊鼻咽癌病人抑郁状态的发生率及危险因素.方法 收集2016年1月至2017年12月四川大学华西医院收治的122例鼻咽癌病人的临床资料,并对病人的性别、年龄、肿瘤分期(cTNM分期)、吸烟史、饮酒史、医疗费用来源、文化程度、癌性疼痛、睡眠状态、血清C反应蛋白(CRP)水平等可能影响其发生抑郁状态的相关因素进行单因素和多因素分析.结果 122例初诊鼻咽癌病人中,有32例出现抑郁状态,抑郁状态的发生率为26.2％(32/122),其中男性17例,女性15例;单因素分析显示,病人年龄、性别、吸烟、疼痛、失眠及血清CRP水平升高与抑郁状态有关(P<0.05),多因素分析显示,鼻咽癌抑郁状态独立危险因素是年龄、吸烟、失眠、血清CRP水平升高(P<0.001).结论 初诊鼻咽癌病人抑郁状态的发生率较高.病人年龄、失眠、吸烟及CRP与初诊鼻咽癌病人抑郁状态独立危险因素.     

乳腺癌125例化疗后疲劳状况影响因素调查

目的探讨乳腺癌患者化疗后疲劳状况及影响因素。方法以符合条件的125例乳腺癌化疗患者为调查对象,完成简易疲乏量表和医院焦虑抑郁量表调查,应用Spearman秩相关评价中重度疲劳和各种危险因素的相关性。结果化疗后72.8%的受访患者有不同程度的疲劳,24.8%的患者有抑郁症状,26.4%的患者有焦虑症状。年龄、焦虑和抑郁与中重度疲劳呈正相关,而婚姻状况、家庭经济水平与中重度疲劳呈负相关。结论年龄、情绪改变、婚姻状况等社会、心理因素与中重度疲劳密切相关,给予系统化整体护理可能会更有效地改善乳腺癌患者的疲劳状态,提高其生活质量。     

慢性前列腺炎合并性功能下降患者精神障碍分析

目的探讨慢性前列腺炎(CP)合并性功能下降者精神障碍的发病情况,评估性功能下降与精神障碍的关系。方法应用Zung焦虑量表(SAS)和抑郁量表(SDS),国际前列腺炎症状指数表(NIH-CPSI),勃起功能指数表(IIEF-5)及自制的相关因素调查表对1 500例CP患者性功能状和精神心理状况进行调查。分析性功能下降的危险因素、精神障碍的发病情况,并进一步分析性功能下降与精神障碍的关系。结果 1 335例符合入选标准,性功能正常者405例(30.3%),性功能下降者930例(69.7%),性功能下降的发生与患者年龄、病程、文化程度有显著相关性(P0.05),而与体重指数、经济收入状况无相关性。性功能下降组焦虑、抑郁、焦虑合并抑郁的检出率分别为27.1%、26.5%、16.2%;性功能正常组其检出率分别为13.1%、11.1%、6.4%;二组间比较差异有显著性(P0.05)。多项式Logistic回归模型分析显示性功能下降为焦虑、抑郁发生的危险因素,且在控制了相关变量后,性功能下降仍为其危险因素。结论 CP患者合并性功能下降者焦虑、抑郁等精神障碍发生率高,性功能下降为精神障碍发生的危险因素。     

胃癌病人化疗期间失眠相关因素分析及护理对策

目的:探讨胃癌患者化疗期间失眠的相关因素,采取护理对策,促进睡眠。方法:以匹兹堡睡眠质量指数量表(PSQI)和自制影响睡眠因素调查表,对60例胃癌化疗患者睡眠状况进行问卷调查。随机分成A、B两组各30例,A组(对照组)针对失眠原因进行常规护理。B组(观察组)在常规护理的基础上有针对性地进行全面评估,制定相应的护理对策。结果:导致失眠的原因依次主要有化疗副作用(疲劳、厌食、恶心呕吐)、负性情感因素(恐惧、焦虑、抑郁)、疼痛、经济压力、医疗氛围、婚姻家庭关系等。B组促进睡眠的方法优于A组(p<0.05)。结论:对胃癌化疗失眠患者采取做好卫生健康宣教、关注患者心理状况、予积极的支持帮助、提供舒适安静的医疗氛围、合理使用药物等有效护理对策能提高患者的睡眠质量。     

乳腺癌患者术后化疗致感染的危险因素分析及防治对策

目的:分析乳腺癌患者术后化疗致感染的相关因素及防治对策。方法:选取2016年1月—2017年10月间乳腺癌术后化疗患者301例资料,统计与分析化疗后致感染发生的相关危险因素。结果:301例患者中发生感染51例占16.94%,其中呼吸道感染占41.18%及手术切口感染占29.41%;患者的不同并发症、引流时间、住院时间及白细胞计数异常等因素是发生感染的主要因素,经组间比较其差异有统计学意义(P<0.05);而不同年龄、手术类型及手术时长与患者术后化疗感染的发生之间经比较其差异无统计学意义(P>0.05);经多因素Logistic回归分析,引流时间>30 d、白细胞计数下降、住院时间>20 d为乳腺癌患者术后化疗感染的重要危险因素(P<0.05)。结论:乳腺癌患者术后化疗易出现呼吸道及切口感染,其中引流及住院时间较长、白细胞计数下降为感染发生的重要危险因素,临床可据此制订有针对性干预方案,以降低术后化疗感染的发生风险。     

糖皮质激素在肿瘤内科临床应用的回顾性研究

目的:回顾分析住院患者使用糖皮质激素(GC)的情况,探讨GC在肿瘤内科临床应用的疗效和安全性.方法:选择2006-2007年本院肿瘤科恶性肿瘤住院患者505例,调查GC应用情况.采用SPSS13.0软件统计分析GC日剂量和连续用药时间(天)相关的疗效和不良反应.建立Logistic回归模型,分析GC的疗效和不良反应及其影响因素.结果:单因素分析显示,对肿瘤相关的急性颅内压增高及放射损害,GC日剂量对疗效影响明显,日剂量对水肿缓解也有一定影响;但对化疗相关的胃肠道反应、过敏,肿瘤直接引起的食欲不振、恶病质无明显影响.GC的连续用药时间对患者食欲改善影响显著.多因素分析显示,患者临床分期、Karnofsky(KPS)评分及化放疗对GC疗效影响有统计学显著意义,其中临床分期、KPS评分、化疗与GC疗效呈正相关;放疗与之呈负相关:年龄、性别、体表面积、基础疾病、诊断分类及是否手术与之相关性不大.不良反应评价显示,GC日剂量与低血钾的发生呈正相关,与血糖、血钙变化、肺部感染、失眠、肝功能损害、消化道溃疡无显著相关性;GC的用药时间与低血钾、高血糖、低血钙、肺部感染及消化道溃疡发生率呈正相关,与失眠、肝功能损害无相关性.低血钾、低血钙、肺部感染、消化道溃疡的共同危险因素为年龄;高血糖惟一危险因素为基础疾病(如糖尿病);失眠、肝功能损害未见明显相关影响因素.结论:适当增加GC的用药剂量及连续用药时间有益于控制肿瘤局部症状和放疗相关不良反应;中等剂量GC短期应用即能减轻化疗相关不良反应;低剂量GC较长时期维持治疗可改善肿瘤患者的全身症状;预防化疗药物相关的不良反应,GC可用或不用.另外,低剂量GC短期应用引起较严重不良反应可能性较低,但需关注老年肿瘤患者长期应用的相关不良反应.     

帕金森病伴发抑郁的临床特点及危险因素分析

目的 探讨帕金森患者伴发抑郁的临床发病率及相关危险因素.方法 随机选取我院2005~2011年诊治的原发性帕金森患者95例,采用Hoehn-Yahr(H-Y)分级评价帕金森患者病情严重程度,采用汉密尔顿抑郁量表(Hamilton Depression Rating Scale,HAMD)评价患者抑郁的病情,对患者的年龄、性别、病程、H-Y分级及左旋多巴日平均用量等进行Logistic回归分析.结果 无抑郁症状者HAMD评分为(3.04±0.87)分,占65.26%(62/95),轻、中、重、度抑郁分布占24.21%(23/95)、7.37%(7/95)及3.16%(3/95);患者年龄、性别及左旋多巴日平均量与HAMD评分无关,而病程、H-Y分级与HAMD评分正相关(P<0.05).结论 帕金森伴发抑郁的发生率高,但以轻度为主,而患者病情严重程度及病程是该病的危险因素.     

卒中后抑郁状态临床分析

目的对卒中后抑郁状态(PSD)发病的相关因素进行分析。方法对198例脑卒中患者进行跟踪随访,Zung抑郁自评量表(SDS)及汉密尔顿抑郁量表-24(HAMD-24)对患者进行评分,对年龄、性别、教育程度、病变部位、病程、卒中类型、神经功能缺损等相关因素进行统计学分析。结果 PSD总发生率为28.3%,其中轻度抑郁占58.9%,中度抑郁占30.4%,重度抑郁占10.7%,表明大部分患者为轻、中度抑郁。影响最大的相关因素是神经功能缺损程度,其次是文化程度及性别。结论性别、教育程度、神经功能缺损程度、病程是引起PSD的相关危险因素,文化程度及性别是可能相关危险因素。     

白血病化疗患者焦虑和抑郁状况评估及护理

目的:了解白血病化疗患者的焦虑和抑郁状况,并分析相关的影响因素,采取相应护理措施。方法:采用医院焦虑及抑郁量表(HADS)对我院2003年1月～2006年2月50例白血病患者接受静脉输液化疗与50例白血病非化疗性输液的住院患者进行调查。结果:接受静脉输液化疗的白血病患者焦虑和抑郁情况与非化疗性输液的白血病患者相比,差异有显著性(P<0.05)。结论:白血病的分型、化疗药物的不良反应、病程长短及经济费用对焦虑和抑郁有不同程度的影响,及时发现焦虑和抑郁问题,采取相应的心理干预,以达到完全缓解并延长生存期的目的。     

大剂量甲氨蝶呤化疗致儿童骨肉瘤患者肝功能损伤的危险因素分析

目的:探讨儿童骨肉瘤患者接受大剂量甲氨蝶呤(HD-MTX)化疗后发生肝功能损伤的特点及危险因素,为临床用药提供参考。方法:回顾性分析北京积水潭医院175例骨肉瘤患儿的临床资料,分析患儿的性别、年龄、累计化疗次数、保肝药种类、HD-MTX结束后0、24、48和72 h血药浓度(C_0、C_(24)、C_(48)和C_(72))对化疗后肝功能损伤的影响。结果:在175例患儿共455例次HD-MTX化疗中,共398例次在化疗后发生肝功能损伤,发生率87.47%。单因素分析结果显示年龄、累计化疗次数、C_(24)、C_(48)和C_(72)等因素与化疗后发生肝功能损伤相关。多因素logistic回归分析显示年龄和C_(24)与化疗后肝功能损伤相关,回归系数分别为-0.172及0.180。结论:HD-MTX引起骨肉瘤患儿肝功能损伤发生率高,临床应加强血药浓度监测及时调整解救方案及后续治疗,减少严重肝功能损伤的发生。     

An international survey of insomnia: under-recognition and under-treatment of a polysymptomatic condition

BACKGROUND: Due to its high prevalence, considerable impact on well-being, and high medical and societal costs, insomnia represents an important healthcare challenge. Despite this, the prevalence of this condition is under-recognized and many sufferers do not receive adequate treatment. OBJECTIVE: This international survey investigated the prevalence and characteristics of insomnia in the general population in France. Italy, Japan and the USA to better understand why insomnia is under-recognized and under-treated. RESEARCH DESIGN AND METHODS: Type, frequency, natural history of night- and day-time symptoms, and attitudes of people regarding the nature and treatment of insomnia was quantitatively assessed from a representative sample of the general population aged > 18 years in each of the four countries. A survey of an extensive series of standardized 10-15-min interviews was conducted over the telephone by professional interviewers. RESULTS: Insomnia was reported by 37.2% of respondents in France and Italy, 6.6% in Japan, and 27.1% in the USA. The mean number of symptoms reported per patient was two, with sleep maintenance insomnia the most predominant symptom (73%), followed by difficulty falling asleep (61%), and poor sleep quality (48%). Daytime fatigue and impaired concentration and attention were the most commonly reported next-day symptoms as a result of poor sleep. The majority of individuals with sleep problems reported being 'somewhat' or 'very' bothered by their symptoms, and reported that their sleep problems impacted on their daily quality of life either 'somewhat' or 'a lot'. Among individuals with a history of insomnia, the rate of reporting insomnia symptoms to physicians was generally low and of those who did consult a physician, few were prescribed any medication. CONCLUSIONS: The results of this study suggest that in Europe, Japan and the USA, the burden of insomnia on sufferers is considerable. Many respondents took no action to alleviate their insomnia symptoms despite the poor sleep impacting on their daily quality of life either 'somewhat' or 'a lot'.     

Comorbidity of irritable bowel syndrome in general practice: a striking feature with clinical implications

BACKGROUND: Somatic comorbid symptoms might identify irritable bowel syndrome patients with different aetiologies and needs of treatment. AIMS: To measure comorbid symptoms in patients with irritable bowel syndrome in general practice, and to explore characteristics of patients with low, intermediate and high somatic comorbidity. METHODS: Prospective study of 208 of 278 consecutive patients with irritable bowel syndrome (Rome II) in nine general practices. Questionnaires assessed 22 comorbid symptoms (subjective health complaint inventory), psychosocial factors including psychological distress (Symptom Check list-10) and quality of life (Short form-12). Subjective health complaint data from 1240 adults (controls) constituted a reference material. Patients with low, intermediate and high somatic comorbidity were identified by a somatic comorbidity score (17 subjective health complaint items). Health care seeking was assessed after 6-9 months. RESULTS: Patients with irritable bowel syndrome (67% females, mean age 50, s.d. 16) reported 20 of 22 comorbid symptoms significantly more frequent than controls (odds ratios = 2-7, P < 0.001). The somatic comorbidity score correlated with psychological distress (R = 0.46, P < 0.001). Patients with high somatic comorbidity reported higher levels of mood disorder, health anxiety, neuroticism, adverse life events and reduced quality of life and increased health care seeking when compared to those with low and intermediate somatic comorbidity (P-values < 0.05). CONCLUSIONS: Our findings support the hypothesis that structured assessment of comorbid somatic symptoms might identify subgroups with different aetiology and needs of treatment.     

The influence of co-morbid IBS and psychological distress on outcomes and quality of life following PPI therapy in patients with gastro-oesophageal reflux disease

Background  A subset of patients with gastro-oesophageal reflux disease (GERD) does not achieve complete symptom resolution with proton pump inhibitor (PPI) therapy. The factors which affect response to PPI therapy in GERD patients remain unclear.
Aims  To determine the prevalence and impact of irritable bowel syndrome (IBS) and psychological distress (PD) on GERD symptoms and disease-specific quality of life (QoL) before and after PPI therapy and to assess the same outcomes before and after PPI therapy in non-erosive reflux disease (NERD) and erosive oesophagitis (EO) GERD patients.
Methods  Patients undergoing oesophago-gastroduodenoscopy (OGD) for heartburn were recruited. Participants completed validated surveys: Digestive Health Symptom Index, Reflux Disease Questionnaire, Quality of Life in Reflux and Dyspepsia and Brief Symptom Inventory (BSI). IBS was defined as >3 Manning criteria and PD as BSI score >63. At OGD, patients were classified as NERD or EO. Patients were treated with rabeprazole 20 mg/day for 8 weeks before completing follow-up surveys.
Results  Of 132 GERD patients enrolled, 101 completed the study. The prevalence rates of IBS and PD were 36% and 41%, respectively. IBS independently predicted worse QoL before and after PPI therapy. PD independently predicted worse GERD symptoms and QoL before and after PPI therapy. There were no differences in symptoms or QoL between NERD and EO patients before or after PPI therapy.
Conclusions  IBS and PD impacted GERD symptoms and QoL before and after PPI therapy. Symptoms and QoL before and after PPI therapy were similar in NERD and EO patients.     

Insomnia severity in chronic kidney disease patients with various therapies

The prevalence of insomnia is greater in end-stage renal disease. The aim of our study was to determine the frequency of insomnia and subclinical insomnia in patients with various dialysis therapy and kidney transplant recipients, in order to assess the severity of insomnia and examine whether there is a difference in severity among groups. In cross-sectional study, we evaluated 120 patients with terminal renal failure. Based on therapy, patients were divided into four groups: hemodiafiltration, standard bicarbonate dialysis, peritoneal dialysis and kidney transplant recipients. The severity of insomnia was evaluated through the use of the Insomnia Severity Index (ISI). Most patients who reported any kind of insomnia problems with ISI were on conventional dialysis (80%), followed by hemodiafiltration (76.7%) and peritoneal dialysis (63.3%). Transplant recipients had least difficulties with insomnia (46.7%). Insomnia Severity Index showed that insomnia in end-stage renal patients is not very severe. Most of the patients had “no clinically significant insomnia”. Our findings indicate that patients on hemodiafiltration and transplant recipients have a significantly lower score on Insomnia Severity Index. Patients with end-stage renal disease have high frequency insomnia problems. However, our study shows that insomnia in these patients is not severe. Insomnia is the most frequent and severest in patients on standard bicarbonate dialysis.     

Gastrointestinal complaints among subjects with depressive symptoms in the general population

Background  Patients with depression have irritable bowel syndrome (IBS) more often than do nondepressed patients, but the comorbidity of depression and gastrointestinal (GI) symptoms in the general population has received little study.
Aim  To study the co-occurrence of depressive and GI symptoms in a general population sample and to assess the rate of health-care utilization particularly for GI reasons among subjects with depressive symptoms.
Methods  A questionnaire containing the Finnish version of the Beck Depression Inventory Short Form and questions covering GI symptoms according to Rome II criteria was mailed to 5000 randomly selected adults.
Results  Response rate was 73%. Prevalence of depressive symptoms was 17% (95% CI: 15.7–18.2). Frequent abdominal pain, diarrhoea, constipation, dyspepsia or IBS were present in 54% of those with depressive symptoms and in 29% of nondepressed controls ( P  < 0.0001). Of those with depressive symptoms, 24% had visited a physician at least once because of abdominal symptoms during the previous year, compared to 13% of controls ( P  < 0.0001).
Conclusions  Depressive symptoms are prevalent in the general population. They are associated with a high rate of GI symptoms, leading to increased use of health-care services and work absenteeism because of abdominal complaints.     

Hand-foot syndrome in patients treated with capecitabine-containing combination chemotherapy

Clinical characteristics and risk factors of hand-foot syndrome were investigated in patients who received capecitabine-containing chemotherapy. Toxicity data were analyzed from 179 patients in 4 prospective clinical trials testing docetaxel/capecitabine/cisplatin in stomach cancer, capecitabine/cisplatin in biliary or stomach cancer, and vinorelbine/capecitabine in breast cancer. Hand-foot syndrome was reported in 116/179 (64.8%) of patients, with grade 3 hand-foot syndrome in 8/179 (4.5%). Hand-foot syndrome first developed within the first 3 chemotherapy cycles in 100/116 (86.2%) patients, with the median onset for all 3 treatment regimens occurring during cycle 2. Because severe reactions were rare, hand-foot syndrome was not a major factor influencing treatment schedule. Risk factor analyses showed that combined use of docetaxel and preceding chemotherapy-related stomatitis were significant risk factors for the development of hand-foot syndrome. Our results suggest that a combined treatment agent and a patient's susceptibility to chemotherapy-related toxicity may increase the risk of capecitabine-induced hand-foot syndrome.     

Residual symptoms in depressed outpatients who respond by 50% but do not remit to antidepressant medication

Little is known about the quantity or quality of residual depressive symptoms in patients with major depressive disorder (MDD) who have responded but not remitted with antidepressant treatment. This report describes the residual symptom domains and individual depressive symptoms in a large representative sample of outpatients with nonpsychotic MDD who responded without remitting after up to 12 weeks of citalopram treatment in the Sequenced Treatment Alternatives to Relieve Depression (STAR*D) study. Response was defined as 50% or greater reduction in baseline 16-item Quick Inventory of Depressive Symptomatology--Self-Report (QIDS-SR??) by treatment exit, and remission as a final QIDS-SR?? of less than 6. Residual symptom domains and individual symptoms were based on the QIDS-SR?? and classified as either persisting from baseline or emerging during treatment. Most responders who did not remit endorsed approximately 5 residual symptom domains and 6 to 7 residual depressive symptoms. The most common domains were insomnia (94.6%), sad mood (70.8%), and decreased concentration (69.6%). The most common individual symptoms were midnocturnal insomnia (79.0%), sad mood (70.8%), and decreased concentration/decision making (69.6%). The most common treatment-emergent symptoms were midnocturnal insomnia (51.4%) and decreased general interest (40.0%). The most common persistent symptoms were midnocturnal insomnia (81.6%), sad mood (70.8%), and decreased concentration/decision making (70.6%). Suicidal ideation was the least common treatment-emergent symptom (0.7%) and the least common persistent residual symptom (17.1%). These findings suggest that depressed outpatients who respond by 50% without remitting to citalopram treatment have a broad range of residual symptoms. Individualized treatments are warranted to specifically address each patient's residual depressive symptoms.     

槐耳颗粒联合化疗对晚期大肠癌的初步临床研究

目的：研究槐耳颗粒对晚期大肠癌化疗患者中医症状及生活质量的影响。方法：将60例符合纳入标准的晚期大肠癌患者,随机分为治疗组和对照组,治疗组30例,采用槐耳颗粒联合化疗,化疗采用FOLFOX4方案;对照组30例,单纯化疗,方案同治疗组。4周期后,分别观察两组患者治疗前后中医症状评分、KPS评分,食欲及体重方面的变化。结果：两组患者在中医症状评分疗效,Kamofsky评分,食欲及体重方面比较差异有统计学意义（P〈0.05）。结论：槐耳颗粒联合化疗可改善晚期大肠癌患者的中医症候及体力状况,提高患者生活质量。     

Psychopharmacological treatment of depression, anxiety, irritability and insomnia in patients receiving interferon-alpha: a prospective case series and a discussion of biological mechanisms

We studied 60 patients receiving a 1-year course of interferon (IFN)-alpha therapy for chronic viral hepatitis. Patients underwent psychiatric assessment before starting the IFN-alpha therapy, and monthly throughout the therapy, using the Structured Clinical Interview for the DSM-III-R, the 17-item Hamilton Depression Rating Scale, the Beck Depression Inventory and the Spielberg State and Trait Anxiety Inventory. Five patients had a baseline diagnosis of major depression and 18 (30%) developed an IFN-alpha-induced psychiatric adverse effect; 12 of these 23 patients received psychopharmacological treatment (patients and clinicians jointly decided the need for treatment). Two of the five patients with baseline depression started an antidepressant treatment (paroxetine) together with the IFN-alpha and successfully completed the IFN-alpha therapy. Ten patients received treatment for the IFN-alpha-induced psychiatric adverse effects (depression in five patients, anxiety in two patients, severe irritability in two patients and insomnia in one patient). Depression was treated with paroxetine, amisulpride or levosulpiride; anxiety and insomnia were treated with benzodiazepines; and irritability was treated with thioridazine. Individual response to medications was measured with the Clinical Global Impression scale. Of the patients with IFN-alpha-induced depression, two received paroxetine (one showed a good response), two received amisulpride (one showed a good response) and one did not respond to levosulpiride but responded to paroxetine. The patients experiencing anxiety or insomnia responded well to benzodiazepines. One patient showed a good response, and one a poor response, to thioridazine for irritability. Only one patient interrupted the therapy because of psychiatric adverse effects. Overall, the 12 patients that received psychopharmacological treatment developed less severe psychopathological symptoms during the IFN-alpha therapy compared to the 11 patients who had untreated baseline depression or untreated IFN-alpha-induced psychiatric adverse effects. Thus, psychopharmacological management can successfully treat psychiatric symptoms in patients who are receiving IFN-alpha.