乳腺癌患者内分泌治疗相关骨关节疼痛发展轨迹及护理启示

doi:10.3761/j.issn.0254-1769.2024.14.010

摘要/Abstract

摘要：

目的探讨乳腺癌患者内分泌治疗相关骨关节疼痛发展轨迹的潜在类别及影响因素，为实施针对性的健康教育提供依据。方法采用便利抽样法，选取2022年1月—7月在湖南省某三级甲等肿瘤专科医院乳腺内科住院或门诊就诊的乳腺癌患者481例作为调查对象。采用一般资料调查表、乳腺癌内分泌治疗患者症状评估量表、焦虑自评量表在患者治疗前1周内进行基线调查，采用乳腺癌内分泌治疗患者症状评估量表在患者治疗后3、6、9个月调查患者骨关节疼痛水平，采用增长混合模型、单因素分析和多元Logistic回归分析数据。结果共418例（86.90%）乳腺癌患者完成随访，发生骨关节疼痛235例（56.22%）。识别出骨关节疼痛发展轨迹的3个潜在类别，分别为高水平-缓慢上升组（11.48%）、低水平-缓慢上升组（44.74%）、无症状组（43.78%）。多元Logistic回归分析结果显示，焦虑、关节疾病史、每天睡眠时长、居住地、家庭月收入、每周运动次数是乳腺癌患者内分泌治疗相关骨关节疼痛水平发展轨迹潜在类别的影响因素（P<0.05）。结论乳腺癌患者内分泌治疗相关骨关节疼痛水平呈现不同的变化轨迹，临床医护人员应重视存在焦虑、关节疾病史、睡眠时间短、家庭经济状况差、居住在市区及每周运动次数少的患者疼痛水平的评估和干预。

关键词: 乳腺肿瘤, 内分泌治疗, 芳香化酶抑制剂, 骨关节疼痛, 发展轨迹, 增长混合模型, 护理

Abstract:

Objective To analyze the development trajectory and predictors of endocrine therapy associated arthralgia in breast cancer patients. Methods From January 2022 to July 2022，breast cancer patients in the breast medicine department or outpatients of a tertiary cancer hospital in Hunan Province were selected as respondents using a convenience sampling method. A baseline survey was conducted using the General Information Questionnaire，the Symptom Assessment Scale for Patients Treated with Endocrine Therapy for Breast Cancer，and the Self-Rating Anxiety Scale within 1 week prior to patient treatment. The Symptom Assessment Scale for Patients Treated with Endocrine Therapy for Breast Cancer was used to assess patients’ arthralgia levels at 3，6，and 9 months after treatment，and data were analyzed using growth mixed model，univariate analysis of variance，and multiple logistic regression. Results A total of 418 breast cancer patients completed the follow-up，with 235 cases（56.22%） developing arthralgia. 3 potential categories of arthralgia develop-ment trajectories were identified：high level-slowly increasing group（11.48%），low level-slowly increasing group（44.74%），and asymptomatic group（43.78%）. The results of multifactorial analysis showed that anxiety，history of bone and joint disease，sleep duration，place of residence，monthly household income，and frequency of exercise were predictors of potential categories for the development of trajectory of arthralgia levels associated with endocrine therapy in breast cancer patients（P<0.05）. Conclusion Arthralgia levels associated with endocrine therapy in breast cancer patients exhibit different trajec-tories，and clinical staff should emphasize the assessment and intervention of pain levels in patients with the anxiety，a history of bone and joint disease，poor sleep，poor finances，living in urban areas，and low frequency of exercise.

Key words: Breast Neoplasms, Endocrine Therapy, Aromatase Inhibitor, Arthralgia, Development Trajectory, Growth Mixed Model, Nursing Care

王莉杰, 彭思意, 陈婕君, 魏涛, 刘佳惠, 胡美红, 李旭英. 乳腺癌患者内分泌治疗相关骨关节疼痛发展轨迹及护理启示[J]. 中华护理杂志, 2024, 59(14): 1732-1738.

WANG Lijie, PENG Siyi, CHEN Jiejun, WEI Tao, LIU Jiahui, HU Meihong, LI Xuying. Analysis of the development trajectory and influencing factors of endocrine therapy associated arthralgia in breast cancer patients[J]. Chinese Journal of Nursing, 2024, 59(14): 1732-1738.

图/表 4

表1 乳腺癌患者的一般资料及骨关节痛发展轨迹潜在类别的单因素分析结果 [例（百分比，%）]

Table 1 Demographic characters and univariate analysis of potential categories of trajectory of arthralgia development in breast cancer patients[cases（percentage，%）]

表2 乳腺癌患者骨关节疼痛发展轨迹潜在类别分析模型拟合结果

Table 2 Model fitting results of potential categories of arthralgia trajectories in breast cancer patients

图1 乳腺癌患者不同疼痛分数潜在类别发展轨迹图

Figure 1 Different latent classes of arthralgia dependency trajectories in breast cancer patients

表3 乳腺癌患者骨关节痛发展轨迹潜在类别的多元Logistic回归分析结果（n=418）

Table 3 Results of multiple logistic regression of arthralgia dependency trajectories category in breast cancer patients（n=418）

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