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

中华肺部疾病杂志(电子版) ›› 2021, Vol. 14 ›› Issue (06) : 729 -733. doi: 10.3877/cma.j.issn.1674-6902.2021.06.005

论著

肺结节患者心理健康状况及影响因素分析

娄月妍¹, 吴学玲¹, 范碧君¹, 崔永奇¹, 吴斌², 傅于捷³, 谭晓明¹, 郑宇¹^,^†(

)

^1. 200120　上海，上海交通大学医学院附属仁济医院呼吸科
^2. 200120　上海，上海交通大学医学院附属仁济医院药剂科
^3. 200120　上海，上海交通大学医学院附属仁济医院胸外科

收稿日期:2021-09-07 出版日期:2021-12-25
通信作者: 郑宇
基金资助:
国家自然科学基金资助项目(81270130)

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

Yueyan Lou¹, Xueling Wu¹, Bijun Fan¹, Yongqi Cui¹, Bin Wu², Yujie Fu³, Xiaoming Tan¹, Yu Zheng¹^,^†()

^1. Department of Pulmonology, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200120, China
^2. Department of Pharmacy, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200120, China
^3. Department of Thoracic Surgery, Renji Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200120, China

Received:2021-09-07 Published:2021-12-25
Corresponding author: Yu Zheng

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引用本文：

娄月妍, 吴学玲, 范碧君, 崔永奇, 吴斌, 傅于捷, 谭晓明, 郑宇. 肺结节患者心理健康状况及影响因素分析[J/OL]. 中华肺部疾病杂志(电子版), 2021, 14(06): 729-733.

Yueyan Lou, Xueling Wu, Bijun Fan, Yongqi Cui, Bin Wu, Yujie Fu, Xiaoming Tan, Yu Zheng. Investigation on psychological and health status and influencing factors of patients with pulmonary nodules[J/OL]. Chinese Journal of Lung Diseases(Electronic Edition), 2021, 14(06): 729-733.

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

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

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