本文選題：腫瘤相關(guān)性抑郁　切入點(diǎn)：氟西汀　出處：《大連醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的：觀察223例晚期惡性腫瘤患者抑郁的發(fā)病情況及其影響因素,以及氟西汀對(duì)腫瘤相關(guān)性抑郁患者的免疫功能及生活質(zhì)量的影響。 方法：本研究選擇2012年4月至2014年3月期間在大連醫(yī)科大學(xué)附屬第一醫(yī)院腫瘤科住院的223例患者為研究對(duì)象,均經(jīng)病理學(xué)及影像學(xué)確診為晚期惡性腫瘤,在確診前無抑郁病史。用DSM-Ⅳ(Diagnostic and Statistical Manual Ⅳ)進(jìn)行惡性腫瘤相關(guān)性抑郁的診斷,并根據(jù)漢密頓抑郁量表(Hamilton Depression Scale,HAMD)(24項(xiàng))法進(jìn)行抑郁情況評(píng)估,診斷為晚期惡性腫瘤相關(guān)性抑郁的患者共94例,無抑郁的患者129例,抑郁發(fā)病率為42.2%,其中診斷為輕-中度腫瘤抑郁84例,重度10例。將94例晚期惡性腫瘤相關(guān)性抑郁患者隨機(jī)分為2組：以47例為對(duì)照組,予以化療；以47例為研究組,予以化療加抗抑郁治療。為排除腫瘤病人被診斷為癌癥之后最初的應(yīng)激心理反應(yīng),故氟西汀治療均在抑郁癥確診3周以后進(jìn)行。抗抑郁治療：氟西汀口服20mg/d,持續(xù)口服至完成2周期化療,同時(shí)按照患者的自身情況進(jìn)行正常的抗腫瘤治療。采用SPSS17.0軟件,對(duì)所有數(shù)據(jù)進(jìn)行統(tǒng)計(jì)學(xué)分析,統(tǒng)計(jì)數(shù)據(jù)均以均數(shù)±標(biāo)準(zhǔn)差表示,抑郁組與無抑郁組中性別、年齡、發(fā)病部位、KPS評(píng)分、化療方案、知情情況及文化程度采用卡方檢驗(yàn)。研究組中自身治療前后比較采用配對(duì)T檢驗(yàn),研究組與對(duì)照組組間比較采用兩獨(dú)立樣本T檢驗(yàn),以漢密頓抑郁量表(24項(xiàng))、腫瘤生活質(zhì)量表中文版(QLQ-C30)以及T細(xì)胞亞群為觀察指標(biāo),以P0.05為差異有統(tǒng)計(jì)學(xué)意義。 結(jié)果：在抑郁組和無抑郁組中,晚期惡性腫瘤患者抑郁發(fā)病情況與性別、KPS評(píng)分、化療方案種類、知情情況、文化程度存在相關(guān)性,有統(tǒng)計(jì)學(xué)差異(P0.05),與年齡及發(fā)病部位無相關(guān)性,無統(tǒng)計(jì)學(xué)差異(P0.05) 在研究組中,治療前后QLQ-C30評(píng)分示：生活質(zhì)量評(píng)分在軀體、角色、情緒功能及整體生活質(zhì)量方面上升,有統(tǒng)計(jì)學(xué)差異(P0.05),在疲乏、疼痛、失眠及食欲減退癥狀中評(píng)分下降,有統(tǒng)計(jì)學(xué)差異(P0.05),在認(rèn)知功能、社會(huì)功能、惡心嘔吐、氣短、便秘、腹瀉及經(jīng)濟(jì)困難方面無統(tǒng)計(jì)學(xué)差異(P0.05)；HAMD評(píng)分下降,有統(tǒng)計(jì)學(xué)差異(P0.05)；T細(xì)胞亞群檢測(cè)中,CD3+、CD4+、CD4+/CD8+較治療前升高,有統(tǒng)計(jì)學(xué)差異(P0.05),CD8+較治療前升高,但無統(tǒng)計(jì)學(xué)差異(P0.05) 在對(duì)照組中,T細(xì)胞亞群檢測(cè)治療前與治療后比較：CD3+、 CD4+/CD8+下降,有統(tǒng)計(jì)學(xué)差異(P0.05),提示化療可減低患者的免疫功能,CD4+、CD8+無統(tǒng)計(jì)學(xué)差異(P0.05)；HAMD評(píng)分有所升高,但無統(tǒng)計(jì)學(xué)差異(P0.05) 研究組和對(duì)照組進(jìn)行比較,研究組中CD3+、CD4+、CD4+/CD8+較對(duì)照組中有提高,有統(tǒng)計(jì)學(xué)差異(P0.05),CD8+較對(duì)照組無統(tǒng)計(jì)學(xué)差異(P0.05)；在情緒功能、失眠、疼痛、食欲減退及整體生活質(zhì)量方面較對(duì)照組改善明顯,有統(tǒng)計(jì)學(xué)差異(P0.05) 結(jié)論：晚期惡性腫瘤患者腫瘤相關(guān)性抑郁在女性、文化程度低、KPS評(píng)分低、化療方案種類多、知情者中發(fā)病率高,應(yīng)重視對(duì)其進(jìn)行心理評(píng)估,及早發(fā)現(xiàn)患者抑郁情況并及時(shí)治療,從而提高晚期惡性腫瘤患者生活質(zhì)量。口服氟西汀治療能在一定程度上改善腫瘤相關(guān)性抑郁患者抑郁情況,提高其生活質(zhì)量,改善免疫功能,延長(zhǎng)生存期。
[Abstract]:Objective : To investigate the incidence of depression in 223 patients with advanced malignant tumor and its influencing factors , as well as the effects of fluoxetine on the immune function and quality of life of patients with tumor - related depression .

Methods : From April 2012 to March 2014 , 223 patients who were hospitalized in the First Affiliated Hospital of Dalian Medical University were diagnosed as advanced malignant tumors .
All the data were analyzed statistically by SPSS 17.0 software . Statistical analysis was performed on all the data after 3 weeks of diagnosis of depression . Statistical analysis was performed on all the data by SPSS 17.0 software .

Results : In the depression group and the non - depression group , the incidence of depression in patients with advanced malignant tumor was correlated with the sex , the kps score , the type of chemotherapy regimen , the knowledge and the degree of culture . There was a statistical difference ( P0.05 ) . There was no correlation between the age and the morbidity , and there was no statistical difference ( P0.05 ) .

In the study group , the scores of QLQ - C30 before and after treatment showed that the QOL scores increased in the aspects of physical , role , emotional function and overall quality of life ( P0.05 ) . There was statistical difference ( P0.05 ) . There was no statistical difference in cognitive function , social function , nausea and vomiting , shortness of breath , constipation , diarrhea and economic difficulties ( P0.05 ) ;
There was a significant difference in the scores ( P0.05 ) .
CD3 + , CD4 + , CD4 + / CD8 + were significantly higher in T cell subgroup than before treatment ( P0.05 ) , CD8 + increased before treatment , but there was no statistical difference ( P0.05 ) .

In the control group , CD3 + , CD4 + / CD8 + decreased before and after treatment : CD3 + , CD4 + / CD8 + decreased significantly ( P0.05 ) , suggesting that chemotherapy could reduce the immune function , CD4 + and CD8 + in patients ( P0.05 ) .
There was an increase in the scores , but there was no statistical difference ( P0.05 ) .

Compared with the control group , the CD3 + , CD4 + , CD4 + / CD8 + in the study group were higher than those in the control group ( P0.05 ) .
There was significant difference in emotion function , insomnia , pain , anorexia and overall quality of life ( P0.05 ) .

Conclusion : In patients with advanced malignant tumor , the relationship of tumor - related depression is low in women , low in degree of culture , low in kps score , more in chemotherapy regimen and high in patients with knowledge . It should be emphasized that depression can be improved in patients with advanced malignant tumor , and the quality of life can be improved .

【學(xué)位授予單位】：大連醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2014
【分類號(hào)】：R730;R749.4

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