發(fā)布時(shí)間：2018-06-24 00:23

  本文選題：甲狀腺結(jié)節(jié) + 甲狀腺微小乳頭狀癌　； 參考：《山東大學(xué)》2017年碩士論文

【摘要】：目的:本研究旨在了解甲狀腺結(jié)節(jié)患者,特別是甲狀腺微小乳頭狀癌(PTMC)患者的心理狀況和生命質(zhì)量及相關(guān)影響因素,同時(shí)研究患者心理狀況、生命質(zhì)量、人格特征及醫(yī)學(xué)應(yīng)對(duì)方式之間的相互關(guān)系。方法1.研究對(duì)象:2016年10月～2016年12月在山東大學(xué)齊魯醫(yī)院內(nèi)分泌科及甲狀腺外科門診及住院的術(shù)前甲狀腺結(jié)節(jié)患者207例為甲狀腺結(jié)節(jié)組,211例來源于健康體檢人群、本院職工及進(jìn)修實(shí)習(xí)人員的健康人作為健康對(duì)照組(Normal,N),簽署知情同意書后確立為研究對(duì)象。甲狀腺結(jié)節(jié)組依照B超及細(xì)針穿刺細(xì)胞學(xué)結(jié)果分為:良性組(Benign,B),甲狀腺微小乳頭狀癌(PTMC)組,結(jié)節(jié)1cm的非甲狀腺微小乳頭狀癌(N-PTMC)組。2.研究方法:采用Zung焦慮自評(píng)量表(SAS)、Zung抑郁自評(píng)量表(SDS)、SF-36健康調(diào)查量表(SF-36)、艾森克人格問卷簡(jiǎn)式量表中國版(EPQ-RSC)、醫(yī)學(xué)應(yīng)對(duì)問卷(MCMQ)和一般情況調(diào)查表進(jìn)行問卷調(diào)查,以了解甲狀腺結(jié)節(jié)患者的心理狀況和生命質(zhì)量及相關(guān)影響因素,同時(shí)探討患者心理狀況、生命質(zhì)量、人格特征及醫(yī)學(xué)應(yīng)對(duì)方式之間的相互關(guān)系。3.數(shù)據(jù)處理和統(tǒng)計(jì)分析:采用SPSS21.0軟件進(jìn)行統(tǒng)計(jì)分析,差異顯著性的檢驗(yàn)標(biāo)準(zhǔn)為0.05,p0.05認(rèn)為差異具有統(tǒng)計(jì)學(xué)意義。兩組人員的匹配情況采用卡方檢驗(yàn)。利用一元線性回歸和多元逐步回歸分析差異具有統(tǒng)計(jì)學(xué)意義的因素;利用Spearman相關(guān)分析患者心理狀況、生命質(zhì)量、人格特征及醫(yī)學(xué)應(yīng)對(duì)方式之間的相關(guān)性。結(jié)果1.甲狀腺結(jié)節(jié)患者焦慮發(fā)生率為10.63%(22/207),抑郁發(fā)生率13.04%(27/207)。健康對(duì)照組焦慮和抑郁發(fā)生率均為1.90%(4/211)。甲狀腺結(jié)節(jié)組SAS、SDS評(píng)分均高于健康對(duì)照組,差異具有統(tǒng)計(jì)學(xué)意義(p0.05)。影響甲狀腺結(jié)節(jié)患者焦慮情緒的因素有:年齡、月收入、生命質(zhì)量、人格特征,年齡小、收入低、生命質(zhì)量差、神經(jīng)質(zhì)特質(zhì)明顯,患者焦慮情緒越嚴(yán)重。影響甲狀腺結(jié)節(jié)患者抑郁癥狀的因素有生命質(zhì)量、人格特征、月收入、應(yīng)對(duì)方式,生命質(zhì)量差、神經(jīng)質(zhì)特質(zhì)突出、收入低以及屈服應(yīng)對(duì)方式明顯的患者抑郁情緒更明顯。甲狀腺結(jié)節(jié)患者的焦慮與抑郁情緒呈正相關(guān),患者的焦慮、抑郁情緒與生命質(zhì)量、外傾及掩飾特質(zhì)呈負(fù)相關(guān),與神經(jīng)質(zhì)特質(zhì)、回避及屈服維度呈正相關(guān)。2.甲狀腺結(jié)節(jié)患者生命質(zhì)量水平下降,且以心理健康相關(guān)生命質(zhì)量下降為主。影響甲狀腺結(jié)節(jié)患者生命質(zhì)量的因素有:年齡、婚姻、月收入、結(jié)節(jié)大小、心理狀況、人格特征。年齡小、已婚、收入低、心理狀況好、性格外向情緒穩(wěn)定,則生命質(zhì)量越高。甲狀腺結(jié)節(jié)患者生命質(zhì)量與外傾及掩飾特質(zhì)呈正相關(guān),與神經(jīng)質(zhì)特質(zhì)、回避及屈服維度呈負(fù)相關(guān)。3.PTMC患者、良性結(jié)節(jié)患者、N-PTMC患者焦慮發(fā)生率分別為11%(11/100)、9.62%(5/52)、10.9%(6/55);抑郁發(fā)生率分別為 13%(13/100)、11.54%(6/52)、14.55%(8/55);健康對(duì)照組焦慮和抑郁發(fā)生率均為1.90%(4/211)。3組患者SAS與SDS評(píng)分較健康人高,3組患者之間SAS與SDS評(píng)分差異無統(tǒng)計(jì)學(xué)意義。影響PTMC患者焦慮癥狀的因素有軀體疼痛、精神健康,軀體疼痛程度重、精神健康評(píng)分低,焦慮情緒越嚴(yán)重。影響PTMC患者抑郁癥狀的因素有軀體疼痛、神經(jīng)質(zhì)、屈服維度,軀體疼痛程度重、神經(jīng)質(zhì)維度和屈服維度評(píng)分高,抑郁情緒越嚴(yán)重。PTMC患者的焦慮與抑郁情緒呈正相關(guān);焦慮、抑郁情緒與生命質(zhì)量、外傾及掩飾特質(zhì)呈負(fù)相關(guān),與神經(jīng)質(zhì)特質(zhì)、回避及屈服維度呈正相關(guān)。4.3組甲狀腺結(jié)節(jié)患者生命質(zhì)量與健康人相比差異具有統(tǒng)計(jì)學(xué)意義,結(jié)節(jié)患者生命質(zhì)量下降,且以心理健康相關(guān)的生命質(zhì)量下降為主。PTMC、N-PTMC、良性組之間生命質(zhì)量差異無統(tǒng)計(jì)學(xué)意義。影響PTMC患者生命質(zhì)量的因素有:婚姻、診斷時(shí)長(zhǎng)、心理狀況、人格特征、醫(yī)學(xué)應(yīng)對(duì)方式。未婚、診斷時(shí)長(zhǎng)短、心理狀況差、性格不穩(wěn)定、屈服應(yīng)對(duì)方式為主的患者生命質(zhì)量更差。PTMC患者的生命質(zhì)量與外傾特質(zhì)呈正相關(guān),與神經(jīng)質(zhì)特質(zhì)呈負(fù)相關(guān)。結(jié)論1.部分甲狀腺結(jié)節(jié)患者包括PTMC患者存在焦慮和抑郁情緒,并受患者生命質(zhì)量、人格、應(yīng)對(duì)方式等因素影響。在治療過程中輔以適當(dāng)?shù)男睦砀深A(yù)以改善患者負(fù)性情緒具有重要意義。2.甲狀腺結(jié)節(jié)患者包括PTMC患者存在生命質(zhì)量水平下降,并受多種因素影響;患者生命質(zhì)量以心理健康相關(guān)的生命質(zhì)量下降為主,改善患者的生命質(zhì)量應(yīng)重視患者心理狀況的改善。3.甲狀腺結(jié)節(jié)患者包括PTMC患者以積極應(yīng)對(duì)方式為主,患者的應(yīng)對(duì)方式與其心理狀況和生命質(zhì)量具有相關(guān)性。采取積極的應(yīng)對(duì)方式有利于改善患者心理狀況、提升生命質(zhì)量。4.PTMC組、非PTMC組以及良性結(jié)節(jié)組之間患者的心理狀況、生命質(zhì)量均無明顯差異,甲狀腺結(jié)節(jié)的性質(zhì)、大小等對(duì)患者心理狀況與生命質(zhì)量的影響無明顯差異。臨床上診療方案的制定在考慮結(jié)節(jié)生物學(xué)行為的基礎(chǔ)上,輔以適當(dāng)?shù)男睦砀深A(yù)具有重要意義。
[Abstract]:Objective: the purpose of this study was to understand the psychological status, quality of life and related factors in patients with thyroid nodules, especially small thyroid papillary carcinoma (PTMC), and to study the relationship between patients' psychological status, quality of life, personality characteristics and medical coping styles. Method 1. subjects: October 2016 to December 2016 207 cases of thyroid nodules in the Department of Endocrinology, the Department of Endocrinology, the thyroid surgery and the hospitalization of the Qilu Hospital in Shandong University were the thyroid nodules, and 211 were from the healthy population. The health control group (Normal, N) was established as the research object after the informed consent book was signed. The group was divided into the benign group (Benign, B), the thyroid micropapillary carcinoma (PTMC) group, the 1cm non thyroid small papillary carcinoma (N-PTMC) group.2. research methods: the Zung anxiety self rating scale (SAS), the Zung depression self rating scale (SDS), the SF-36 health survey scale (SF-36), and the Eysenck personality questionnaire. The Chinese version of the scale (EPQ-RSC), the Medical Coping Questionnaire (MCMQ) and the general situation questionnaire were used to investigate the psychological status, quality of life and related factors of thyroid nodules, and the relationship between the psychological status, quality of life, personality characteristics and medical coping styles of patients with.3. data processing and statistical analysis. Analysis: the statistical analysis was carried out by SPSS21.0 software. The standard of difference significance was 0.05, and P0.05 thought the difference was statistically significant. The matching of the two groups was checked by chi square test. The factors of statistical significance were analyzed by the linear regression and multiple stepwise regression, and the psychological status of the patients was analyzed by Spearman correlation. Results 1. the incidence of anxiety in 1. patients with thyroid nodules was 10.63% (22/207), and the incidence of depression was 13.04% (27/207). The incidence of anxiety and depression in the healthy control group was 1.90% (4/211). The thyroid nodule group was SAS, and the SDS score was higher than that in the healthy control group, the difference was statistically significant ( P0.05). The factors affecting the anxiety of patients with thyroid nodules are age, monthly income, life quality, personality, age, low income, poor quality of life, significant neuroticism and severe anxiety. The factors affecting the depressive symptoms of thyroid nodules are characterized by quality of life, personality, monthly income, coping style, life quality. There was a positive correlation between anxiety and depression in patients with thyroid nodules, and the anxiety and depression of the patients were negatively related to the quality of life, extroversion and disguise, and the.2. thyroid was positively related to the hypothyroidism, avoidance and yield dimensions. The quality of life of the patients with nodules was reduced and the quality of life related to mental health decreased mainly. The factors affecting the quality of life of the thyroid nodules were age, marriage, monthly income, nodule size, psychological status, personality characteristics. Age, marriage, low income, good mental condition, and stable extrovert, the higher the quality of life. The quality of life of patients with adenoid nodules was positively correlated with extroversion and disguise. The incidence of anxiety in.3.PTMC patients with neuroticism, avoidance and yield dimension was 11% (11/100), 9.62% (5/52), 10.9% (6/55) respectively in patients with benign nodules, 13% (13/100), 11.54% (6/52), 14.55% (8/55), and 14.55% (8/55), and healthy control group). The incidence of anxiety and depression were all 1.90% (4/211).3 patients with SAS and SDS scores higher than those of the healthy people. There was no statistical difference between the 3 groups of patients with SAS and SDS scores. The factors affecting the anxiety symptoms of PTMC patients were somatic pain, mental health, somatic pain, low mental health score, and more serious anxiety. It affected PTMC patients' depression. The factors such as somatic pain, neuroticism, yield dimension, heavy somatic pain, high neuroticism and yield dimension, the more depressed mood of.PTMC patients were positively correlated with depression and depression, and anxiety and depression were negatively correlated with quality of life, extroversion and disguise, with neuroticism, avoidance and yield dimension. The quality of life of the patients with thyroid nodules in the.4.3 group was statistically significant compared with those of the healthy people. The quality of life of the patients with nodules decreased, and the quality of life related to the mental health decreased mainly.PTMC, and the quality of life between the benign groups was not statistically significant. The factors affecting the quality of life of the PTMC patients were: marriage, and the length of diagnosis. Psychological status, personality characteristics, medical coping style, unmarried, poor diagnosis, poor mental condition, unstable character, and poor quality of life, the quality of life of.PTMC patients was positively correlated with extroversion, and negative correlation with neuroticism. Conclusion the 1. part of the thyroid nodules, including PTMC patients, had a coke. Anxiety and depression are influenced by factors such as quality of life, personality, coping style, and other factors. In the process of treatment, appropriate psychological intervention is important to improve patients' negative emotions..2. thyroid nodules, including PTMC patients, have a decline in the quality of life and are affected by a variety of factors; the quality of life of the patients is psychological health. To improve the quality of life and improve the quality of life of the patients, the improvement of the quality of life of the patients should be paid more attention to the improvement of the psychological status of patients with.3. thyroid nodules, including the positive coping style of the patients with PTMC, the coping style of the patients is related to their psychological status and the quality of life. There was no significant difference in the mental condition between the.4.PTMC group, the non PTMC group and the benign nodule group. There was no significant difference in the quality of life between the thyroid nodules and the size of the thyroid nodules. The formulation of the clinical diagnosis and treatment scheme was based on the biological behavior of the nodules, supplemented by the appropriate treatment. Psychological intervention is of great significance.
【學(xué)位授予單位】：山東大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R581

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8 譯 小玉;人類壽命延長(zhǎng) 但生命質(zhì)量下降[N];中國醫(yī)藥報(bào);2013年

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10 顧德寧;醫(yī)療定價(jià)要以提高生命質(zhì)量為標(biāo)準(zhǔn)[N];新華日?qǐng)?bào);2006年

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