肺结节患者心理健康状况及影响因素分析

doi:10.3877/cma.j.issn.1674-6902.2021.06.005

目的

分析肺结节患者的心理健康状况及影响因素。

方法

通过问卷调查的形式对偶发肺结节的成人进行横断面调查。

结果

通过对178例肺结节患者的焦虑和抑郁程度评价，发现大多数肺结节患者有轻度或中度焦虑。根据IES-R评分方差分析，女性患者比男性患者更易出现焦虑状态(P＝0.036)。其他组别的IES-R评分之间无统计学差异。单变量Logistic回归分析显示，结节直径越大焦虑水平程度越高(P＝0.041)，"在CT上看到肺结节"(P＝0.001)会增加焦虑水平，如何解释"肺结节很常见"可以减轻患者焦虑程度(P＝0.006)。多因素回归分析显示，年轻(P＝0.010)、低月收入(P＝0.014)和结节直径较大(P＝0.038)与较高的焦虑水平相关，"在CT上看到肺结节"可导致焦虑水平升高(P＝0.002)。EQ-5D-5L效用得分为0.9578±0.0634，EQ-5D-5L量表对肺结节患者健康相关生活质量的评价是可以接受的，EQ-5D-5L效用与事件影响量表修订版(IES-R)得分呈负相关(r＝0.3495，P<0.0001)。

结论

肺结节人群中女性较男性更容易焦虑；如果患者自己在CT上看到肺结节，会增加焦虑程度。告诉患者肺结节很常见，可以降低焦虑水平。

关键词: 肺结节, 焦虑, 医患沟通, EQ-5D-5L, 事件影响量表修订版

Objective

To examine the psychological and health status of patients with pulmonary nodules.

Methods

It was administered that a cross-sectional survey to adults with incidental pulmonary nodules.

Results

Through the evaluation of anxiety and depression in 178 patients with pulmonary nodules, It was found that most patients with pulmonary nodules had mild or moderate anxiety. According to the analysis of variance of IES-R score, female patients were more prone to anxiety than male patients (P=0.036). There was no significant difference in IES-R scores among other groups. Univariate logistic regression analysis showed that the larger the diameter of the nodule, the higher the degree of anxiety (P=0.041), "seeing pulmonary nodule on CT" (P=0.001) would increase the level of anxiety, if the doctor explained that "pulmonary nodule is very common" could reduce the degree of anxiety (P=0.006). Multivariate regression analysis showed that younger age (P=0.010), lower monthly income (P=0.014) and larger nodule diameter (P=0.038) were associated with higher anxiety level, "seeing pulmonary nodules on CT" could lead to higher anxiety level (P=0.002). The utility score of EQ-5D-5L was 0.9578±0.0634 The utility of EQ-5D-5L was negatively correlated with the score of IES-R (r=-0.3495, P<0.0001).

Conclusions

Female patients were more anxious than male patients. If patients have seen the pulmonary nodules on CT themselves, this can increase the anxiety levels. If a doctor has told a patient that pulmonary nodules are common before CT imaging, this can reduce the anxiety levels.

Key words: Pulmonary nodules, Anxiety, Communication, EQ-5D-5L, IES-R

表1 肺结节患者的临床特征

临床资料		n＝178(%)
性别(%)^a　男/女		43.8/56.2
年龄(岁)(Mean±SD)		51(13.2)
朋友或家人罹患肺癌　是/否		21.3/78.7
吸烟
	否，但曾有吸烟史	14.0
	是	20.8
	无	65.2
教育程度
	未上学	3.4
	小学	12.9
	初中	34.8
	高中	20.8
	大学以上	28.1
月收入
	<3 000 RMB	30.9
	3000~6000 RMB	36.0
	6000~10000 RMB	21.3
	>10 000 RMB	11.8
婚姻
	未婚	4.5
	已婚	93.8
	离婚	1.7
孩子是否入学　是/否		32.6/67.4
发现结节的时间
	<1 day	26.4
	0~3月	11.2
	3~6月	10.1
	6~12月	9.0
	>12月	43.3
结节大小
	<3 mm	29.8
	3~6 mm	50.0
	6~8 mm	15.2
	>8 mm	5.1

表1 肺结节患者的临床特征

临床资料		n＝178(%)
性别(%)^a　男/女		43.8/56.2
年龄(岁)(Mean±SD)		51(13.2)
朋友或家人罹患肺癌　是/否		21.3/78.7
吸烟
	否，但曾有吸烟史	14.0
	是	20.8
	无	65.2
教育程度
	未上学	3.4
	小学	12.9
	初中	34.8
	高中	20.8
	大学以上	28.1
月收入
	<3 000 RMB	30.9
	3000~6000 RMB	36.0
	6000~10000 RMB	21.3
	>10 000 RMB	11.8
婚姻
	未婚	4.5
	已婚	93.8
	离婚	1.7
孩子是否入学　是/否		32.6/67.4
发现结节的时间
	<1 day	26.4
	0~3月	11.2
	3~6月	10.1
	6~12月	9.0
	>12月	43.3
结节大小
	<3 mm	29.8
	3~6 mm	50.0
	6~8 mm	15.2
	>8 mm	5.1

图1 发现肺结节后的医患沟通

表2 肺结节患者焦虑和抑郁危险因素的单因素和多因素回归分析

临床资料	单因素回归分析OR(95%CI)，P值		多因素回归分析OR(95%CI)，P值
临床资料	中　度	重　度	中　度	重　度
性　别	1.704(0.912~3.181) 0.095	2.378(0.755~7.495) 0.139	1.990(0.996~3.977) 0.051	3.014(0.805~11.283) 0.101
年龄	1.003(0.980~1.027) 0.786	0.973 (0.934~1.014) 0.197	0.990 (0.961~1.020) 0.498	0.930 (0.880~0.983) 0.010
朋友或家人罹患肺癌	0.636 (0.299~1.355) 0.241	1.556 (0.317~7.634) 0.586
吸烟	1.147 (0.755~1.744) 0.519	1.648 (0.692~3.920) 0.259
教育程度	0.994 (0.755~1.307) 0.964	0.936 (0.581~1.507) 0.785
月收入	0.793 (0.579~1.086) 0.147	0.642 (0.356~1.158) 0.141	0.791 (0.531~1.179) 0.250	0.374 (0.171~0.818) 0.014
婚姻状态	1.042 (0.293~3.701) 0.949	0.583 (0.080~4.264) 0.595
孩子是否入学	1.091 (0.562~2.118) 0.797	0.618 (0.206~1.851) 0.390
发现结节时间	1.092 (0.911~1.310) 0.342	1.098 (0.797~1.511) 0.569
结节大小	0.845 (0.568~1.257) 0.405	1.914 (1.027~3.567) 0.041	0.869 (0.567~1.333) 0.521	2.081 (1.042~4.159) 0.038
医师是否指出结节大小	0.900 (0.454~1.785) 0.763	1.125 (0.326~3.879) 0.852
是否在CT上看到结节	3.070 (1.594~5.912) 0.001	1.139 (0.388~3.345) 0.813	3.091 (1.515~6.305) 0.002	1.319 (0.390~4.467) 0.656
医师是否阐述肺癌的可能性	0.774 (0.267~2.245) 0.637	1.232 (0.236~6.432) 0.804
医师是否说明结节的不确定性	0.771 (0.389~1.529) 0.457	2.839 (0.946~8.523) 0.063	1.187 (0.555~2.541) 0.659	3.149 (0.912~10.871) 0.070
医师是否解释结节的常见性	0.404 (0.211~0.774) 0.006	1.320 (0.446~3.901) 0.616	0.514 (0.252~1.045) 0.066	0.979 (0.290~3.297) 0.972

表2 肺结节患者焦虑和抑郁危险因素的单因素和多因素回归分析

临床资料	单因素回归分析OR(95%CI)，P值		多因素回归分析OR(95%CI)，P值
临床资料	中　度	重　度	中　度	重　度
性　别	1.704(0.912~3.181) 0.095	2.378(0.755~7.495) 0.139	1.990(0.996~3.977) 0.051	3.014(0.805~11.283) 0.101
年龄	1.003(0.980~1.027) 0.786	0.973 (0.934~1.014) 0.197	0.990 (0.961~1.020) 0.498	0.930 (0.880~0.983) 0.010
朋友或家人罹患肺癌	0.636 (0.299~1.355) 0.241	1.556 (0.317~7.634) 0.586
吸烟	1.147 (0.755~1.744) 0.519	1.648 (0.692~3.920) 0.259
教育程度	0.994 (0.755~1.307) 0.964	0.936 (0.581~1.507) 0.785
月收入	0.793 (0.579~1.086) 0.147	0.642 (0.356~1.158) 0.141	0.791 (0.531~1.179) 0.250	0.374 (0.171~0.818) 0.014
婚姻状态	1.042 (0.293~3.701) 0.949	0.583 (0.080~4.264) 0.595
孩子是否入学	1.091 (0.562~2.118) 0.797	0.618 (0.206~1.851) 0.390
发现结节时间	1.092 (0.911~1.310) 0.342	1.098 (0.797~1.511) 0.569
结节大小	0.845 (0.568~1.257) 0.405	1.914 (1.027~3.567) 0.041	0.869 (0.567~1.333) 0.521	2.081 (1.042~4.159) 0.038
医师是否指出结节大小	0.900 (0.454~1.785) 0.763	1.125 (0.326~3.879) 0.852
是否在CT上看到结节	3.070 (1.594~5.912) 0.001	1.139 (0.388~3.345) 0.813	3.091 (1.515~6.305) 0.002	1.319 (0.390~4.467) 0.656
医师是否阐述肺癌的可能性	0.774 (0.267~2.245) 0.637	1.232 (0.236~6.432) 0.804
医师是否说明结节的不确定性	0.771 (0.389~1.529) 0.457	2.839 (0.946~8.523) 0.063	1.187 (0.555~2.541) 0.659	3.149 (0.912~10.871) 0.070
医师是否解释结节的常见性	0.404 (0.211~0.774) 0.006	1.320 (0.446~3.901) 0.616	0.514 (0.252~1.045) 0.066	0.979 (0.290~3.297) 0.972

图2 肺结节患者IES-R和EQ-5D-5L评分之间的相关性

1	范卫杰，张　冬. 影像组学及深度学习在肺结节良恶性鉴别诊断中的新理念[J/CD]. 中华肺部疾病杂志(电子版), 2021, 14(5): 549-553.
2	Jennifer MB, Adam TF, Jason AW, et al. Adenocarcinoma in situ, minimally invasive adenocarcinoma, and invasive pulmonary adenocarcinoma-analysis of interobserver agreement, survival, radiographic characteristics, and gross pathology in 296 nodules[J]. Hum Pathol, 2016, 51: 41-50.
3	周清华，范亚光，王　颖，等. 中国肺癌低剂量螺旋CT筛查指南(2018年版)[J]. 中国肺癌杂志，2018, 21(2): 67-75.
4	赵俊松，崔　利，何江波，等. 上海22 351例无症状体检者低剂量CT肺癌筛查及随访结果初步分析[J]. 诊断学理论与实践，2019, 18(2): 183-188.
5	US Preventive Services Task Force, Alex HK, Karina WD, et al. Screening for lung cancer: US preventive services task force recommendation statement[J]. JAMA, 2021, 325(10): 962-970.
6	Lea A, Jane PK, Sophie LW, et al. Incidental lung nodules on cross-sectional imaging: current reporting and management[J]. Radiol Clin North Am, 2021, 59(4): 535-549.
7	Kaleen K, Mark S, Lyall G, et al. Evaluation of high-risk pulmonary nodules and pathologic correlation in patients enrolled in a low-dose computed tomography (LDCT) program[J]. J Thorac Dis, 2019, 11(4): 1165-1169.
8	Daria M, Jean MS, Jana T, et al. The lung reporting and data system (LU-RADS): a proposal for computed tomography screening[J]. Can Assoc Radiol J, 2014, 65(2): 121-134.
9	Joseph S. Psychometric evaluation of Horowitz′s impact of event scale: a review[J]. J Trauma Stress, 2000, 13(1): 101-113.
10	EuroQol Group. EuroQol-a new facility for the measurement of health-related quality of life[J]. Health Policy, 1990, 16(3): 199-208.
11	Nord E. EuroQol: health-related quality of life measurement. Valuations of health states by the general public in Norway[J]. Health Policy, 1991, 18(1): 25-36.
12	Lamers LM, Bouwmans CAM, van Straten A, et al. Comparison of EQ-5D and SF-6D utilities in mental health patients[J]. Health Econ, 2006, 15(11): 1229-1236.
13	Wang K, Guo XP, Yu SY, et al. Mapping of the acromegaly quality of life questionnaire to ED-5D-5L index score among patients with acromegaly[J]. Eur J Health Econ, 2021, 22(9): 1381-1391.
14	Slatore CG, Wiener RS, Golden SE, et al. Longitudinal assessment of distress among veterans with incidental pulmonary nodules[J]. Ann Am Thorac Soc, 2016, 13(11): 1983-1991.
15	Kozuka T, Johkoh T, Hamada S, et al. Detection of pulmonary metastases with multi-detector row CT scans of 5-mm nominal section thickness: autopsy lung study[J]. Radiology, 2003, 226(1): 231-234.
16	Dao TK, Youssef NA, Armsworth M, et al. Randomized controlled trial of brief cognitive behavioral intervention for depression and anxiety symptoms preoperatively in patients undergoing coronary artery bypass graft surgery[J]. J Thorac Cardiovasc Surg, 2011, 142(3): e109-e115.
17	Zahra K, Leila J, Saeedeh H. Role of anxiety and depression in adolescents with chest pain referred to a cardiology clinic[J]. Cardiol Young, 2017, 27(1): 125-130.
18	Melissa O, Ian W. Asthma and depression: a pragmatic review of the literature and recommendations for future research[J]. Clin Pract Epidemiol Ment Health, 2005, 1: 18.
19	Dariusz K, Małgorzata MM, Robert G, et al. Analysis of anxiety, depression and aggression in patients attending pain clinics[J]. Int J Environ Res Public Health, 2018, 15(12): 2898.
20	Christopher GS, Sara EG, Linda G, et al. Distress and patient-centered communication among veterans with incidental (not screen-detected) pulmonary nodules. A cohort study[J]. Ann Am Thorac Soc, 2015, 12(2): 184-192.
21	王丽娜，韦媛媛，胡华青，等. 肺结节患者焦虑抑郁与Th17/Treg和炎症水平改变的相关性研究[J]. 中国癌症杂志，2020, 23(7): 554-560.
22	Ilana FG, Duan FG, Erin MG, et al. Impact of lung cancer screening results on participant health-related quality of life and state anxiety in the national lung screening trial[J]. Cancer, 2014, 120(21): 3401-3409.
23	Marc RF, Jack AC, Christopher GS, et al. Patients′ Knowledge, Beliefs, and distress associated with detection and evaluation of incidental pulmonary nodules for cancer: results from a multicenter survey[J]. J Thorac Oncol, 2016, 11(5): 700-708.
24	Renda SW, Michael KG, Steven W, et al. What do you mean, a spot: A qualitative analysis of patients′ reactions to discussions with their physicians about pulmonary nodules[J]. Chest, 2013, 143(3): 672-677.
25	Christopher GS, Nancy P, David HA, et al. What the heck is a "nodule" A qualitative study of veterans with pulmonary nodules[J]. Ann Am Thorac Soc, 2013, 10(4): 330-335.
26	Donald RS, Sara EG, Linda G, et al. "I still don′t know diddly" ：a longitudinal qualitative study of patients′knowledge and distress while undergoing evaluation of incidental pulmonary nodules[J]. NPJ Prim Care Respir Med, 2015, 25: 15028.
27	Catherine H, Martin F, Jeannie LH, et al. Measuring patients′perceptions of patient-centered care: a systematic review of tools for family medicine[J]. Ann Fam Med, 2011, 9(2): 155-164.
28	Brooks R. EuroQol: the current state of play[J]. Health Policy, 1996, 37(1): 53-72.
29	Ryo K, Ami K, Masahiro M, et al. Quality assessment using EQ-5D-5L after lung surgery for non-small cell lung cancer (NSCLC) patients[J]. Gen Thorac Cardiovasc Surg, 2019, 67(12): 1056-1061.
30	Zeng XY, Sui M, Liu B, et al. Measurement properties of the EQ-5D-5L and EQ-5D-3L in six commonly diagnosed cancers[J]. Patient, 2021, 14(2): 209-222.
31	Boglárka LS, Larissa S, Florian K, et al. Measuring quality of life in COPD patients: comparing disease-specific supplements to the EQ-5D-5L[J]. Expert Rev Pharmacoecon Outcomes Res, 2020, 20(5): 523-529.
32	Margarethe EW, Rudolf AJ, Annika K, et al. Assessing health-related quality of life in COPD: comparing generic and disease-specific instruments with focus on comorbidities[J]. BMC Pulm Med, 2016, 16(1): 70.

[1]	吴晶晶, 胡倩, 李华凤. 围产期焦虑/抑郁与分娩疼痛相关性的研究现状[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 156-161.
[2]	陈经欣, 李梅, 陈洁雅. 肺结节胸腔镜术后肺部感染危险因素分析[J]. 中华实验和临床感染病杂志(电子版), 2023, 17(04): 238-243.
[3]	王琦, 陈新, 闵捷, 方露, 刘志奇, 孙伟, 于德新. 膀胱软镜镜检术中改良"Bag Squeeze"法的应用与疼痛焦虑影响因素分析[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(03): 237-241.
[4]	戴玮, 江桂林, 车兆平, 张姣, 王星星, 赵海涛. 无缝手术护理在腹股沟疝腹腔镜手术围手术期的应用效果[J]. 中华疝和腹壁外科杂志(电子版), 2023, 17(06): 778-781.
[5]	任茂玲, 孙晓容, 何晓丽. CT引导下微波消融术在肺部结节治疗中的应用及术后并发症的危险因素分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(05): 718-720.
[6]	蒋丽, 王晓慧, 李维益, 苟双芸, 丁敏, 杨丽. 创新智能健康教育与随访管理对肺结节患者焦虑的影响随机对照研究[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 485-489.
[7]	张荷连, 刘禹, 李丹妮, 彭茹, 杨彩蝶, 窦恒, 吴红梅. 心理障碍对重度哮喘患者的疾病控制及生活工作质量的影响[J]. 中华肺部疾病杂志(电子版), 2023, 16(04): 589-591.
[8]	李华娟, 唐英俊, 王赛妮, 徐旺, 林玲, 李羲, 黄华萍. 肺结节临床与CT影像学特征分析及良恶性预测模型构建[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 318-323.
[9]	王洪武, 方碧霞. 基于人工智能探讨多发性肺结节的诊治策略[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 301-305.
[10]	赵晓红, 修翠萍, 张瑜, 吴珂. 大康复理念在COPD稳定期肺康复治疗的临床应用[J]. 中华肺部疾病杂志(电子版), 2023, 16(03): 424-426.
[11]	胥凯凯, 李铁铮, 刘春全, 崔永. 肺小结节精准定位日间手术流程及临床疗效分析[J]. 中华肺部疾病杂志(电子版), 2023, 16(02): 230-232.
[12]	赵志鹏, 马永富, 冯长江, 张猛, 刘阳. 以肺亚段为解剖单位的精准肺外科手术策略的初步报道[J]. 中华腔镜外科杂志(电子版), 2023, 16(02): 85-90.
[13]	吴玥琳, 欧泳琳, 肖海燕, 段业英, 陆翠薇, 李德阳, 王懿春, 唐灏珂. 危重症孕产妇的心理状况及其影响因素的调查[J]. 中华重症医学电子杂志, 2023, 09(02): 198-204.
[14]	付强, 秦丽媛, 李全波. 神经病理性疼痛患者血清miR-15a水平及意义分析[J]. 中华脑科疾病与康复杂志(电子版), 2023, 13(05): 293-298.
[15]	文明, 熊英, 艾克拜尔·艾力, 克力木·阿不都热依木. 质子泵抑制剂治疗期间焦虑对胃食管反流病疗效的影响[J]. 中华胃食管反流病电子杂志, 2023, 10(02): 90-95.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Investigation on psychological and health status and influencing factors of patients with pulmonary nodules

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Investigation on psychological and health status and influencing factors of patients with pulmonary nodules