乳腺癌患者化疗前后症状特征的潜在转变分析及护理对策

doi:10.3761/j.issn.0254-1769.2025.02.010

摘要/Abstract

摘要：

目的探讨乳腺癌患者化疗前后症状潜在类别随时间变化趋势并进一步分析其影响因素，旨在为临床护理实践提供借鉴。方法采取便利抽样法，选取2023年6月—10月在宁夏回族自治区某三级甲等医院就诊的233例乳腺癌患者为调查对象，采用一般资料调查表、中文版安德森症状评估量表，对首次化疗前1~3 d（化疗前，233例），第3次或第4次化疗后7~14 d（化疗后，225例）的乳腺癌患者症状特征进行潜在转变分析。结果 225例乳腺癌患者完成2次调查，化疗前后其症状特征可分为高症状困扰组、低症状困扰组2个类别。高症状困扰组稳定性强，保持原组的概率为85.20%。低症状困扰组更倾向于向高症状困扰组转变，转变概率为26.60%。Logistic回归分析显示，包块部位在左侧、获取疾病知识最主要途径为网络的患者更容易从高症状困扰组转变为低症状困扰组，而在职、夜间睡眠不满意及从不运动的患者更容易从低症状困扰组转变为高症状困扰组。结论乳腺癌患者化疗前后的症状特征存在人群异质性，在职、夜间睡眠不满意及从不运动的乳腺癌患者更容易从低症状困扰组转变为高症状困扰组，提示医护人员早期识别潜在高风险人群，根据不同类别的人群特征实施症状动态监测的基础上，充分运用症状特征的预测作用进行个体化管理，从而减轻症状负担，提高其生活质量。

关键词: 乳腺癌, 术后化疗, 潜在剖面分析, 潜在转变分析, 影响因素分析, 护理

Abstract:

Objective To explore the time-varying pattern of potential symptoms in breast cancer patient before and after chemotherapy，and further analyze its influencing factors，aims to provide reference for clinical nursing practice. Methods 233 cases of breast cancer in a tertiary A hospital in Ningxia from June to October，2023 were selected as the research subjects. By the general information questionnaire and the Chinese version of Anderson Symptom Assessment Scale，the potential change of symptoms of breast cancer patients undergoing chemotherapy 1-3 days before the first chemotherapy（T1，233 cases） and 7-14 days after the third or fourth chemotherapy（T2，225 cases） was analyzed. Results 225 cases of breast cancer patients completed 2 surveys，and their symptom characteristics before and after chemotherapy can be divided into 2 categories：a high symptom troubled group and a low symptom troubled group. The high-symptom troubled group has strong stability，and the probability of maintaining the original group is 85.20%，while the low-symptom troubled group is more inclined to change to the high-symptom troubled group，and the transition probability is 26.60%. Logistic regression analysis showed that the mass was located on the left side，and the patients who obtained disease knowledge mainly through the Internet were more likely to change from the high symptom troubled group to the low symptom troubled group，while the patients who were employed，with unsatisfactory sleep at night，and never exercised were more likely to change from the low symptom troubled group to the high symptom troubled group. Conclusion The symptoms of breast cancer patients before and after chemotherapy are heterogeneous. Patients who are on the job，have unsatisfied sleep at night and never exercise are more likely to change from the low-symptom troubled group to the high-symptom troubled group，which suggests that medical staff should identify potential high-risk groups at an early stage，and make full use of the predictive function of symptom characteristics to carry out individualized management based on the dynamic monitoring of symptoms according to different types of population characteristics，so as to reduce the burden of symptoms and improve their quality of life.

Key words: Breast Cancer, Postoperative Chemotherapy, Latent Profile Analysis, Latent Transition Analysis, Root Cause Analysis, Nursing Care

铁万琴, 张曦, 王永琦, 许洋, 陈雪丰, 潘璐, 陈思羽. 乳腺癌患者化疗前后症状特征的潜在转变分析及护理对策[J]. 中华护理杂志, 2025, 60(2): 193-200.

TIE Wanqin, ZHANG Xi, WANG Yongqi, XU Yang, CHEN Xuefeng, PAN Lu, CHEN Siyu. Analysis of potential changes in symptom characteristics of breast cancer patients before and after chemotherapy and nursing countermeasures[J]. Chinese Journal of Nursing, 2025, 60(2): 193-200.

图/表 6

表1 乳腺癌患者化疗前后症状发生率及严重程度（n=225）

Table 1 Incidence and severity of symptoms in breast cancer patients before and after chemotherapy（n=225）

表2 乳腺癌患者化疗前后症状特征潜在剖面分析（n=225）

Table 2 Potential profile analysis of symptom characteristics of breast cancer patients before and after chemotherapy（n=225）

图1 乳腺癌患者化疗前后症状特征两类别分布图

Figure 1 Distribution of symptoms and characteristics of breast cancer patients before and after chemotherapy

表3 乳腺癌患者化疗前后症状特征的潜在状态概率和潜在转变概率（n=225）

Table 3 Potential state probability and potential transi-tion probability of symptom characteristics of breast cancer patients before and after chemotherapy（n=225）

表4 乳腺癌患者化疗前后症状特征潜在类别单因素分析[n=225，例（百分比，%）]

Table 4 Single factor analysis of potential categories of symptoms in breast cancer patients before and after chemotherapy[n=225，case（percentage，%）]

表5 乳腺癌患者化疗前后症状特征的协变量影响下潜在类别转变概率的发生比（n=225）

Table 5 The occurrence ratio of latent class transition probability under the influence of covariates in symptom characteristic of breast cancer patients before and after chemotherapy（n=225）

参考文献 22

[1]	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022:GLOBOCAN estimates of incidence and mortality world-wide for 36 cancers in 185 countries[J]. CA Cancer J Clin, 2024, 74(3):229-263.
[2]	陆韬华吾, 陆箴琦. 乳腺癌术后化疗患者睡眠障碍变化规律及预测指标研究[J]. 护理学杂志, 2021, 36(18):1-5,21.
	Lu THW, Lu ZQ. Trajectories and predictors of sleep distur-bance in patients receiving chemotherapy for breast cancer[J]. J Nurs Sci, 2021, 36(18):1-5,21.
[3]	Fox RS, Ancoli-Israel S, Roesch SC, et al. Sleep dis-turbance and cancer-related fatigue symptom cluster in breast cancer patients undergoing chemotherapy[J]. Support Care Cancer, 2020, 28(2):845-855.
[4]	王欢, 刘佳, 尹玉丽. 分级管理护理联合渐进式肌肉放松训练对乳腺癌化疗所致恶心呕吐的临床效果[J]. 中国肿瘤临床与康复, 2022, 29(7):890-893.
	Wang H, Liu J, Yin YL. Clinical efficacy of hierarchical management nursing combined with progressive muscle relaxa-tion training for chemotherapy induced nausea and vomiting in breast cancer[J]. Chin J Clin Oncol Rehabil, 2022, 29(7):890-893.
[5]	Cortés de Miguel S, Calleja-Hernández Má, Menjón-Beltrán S, et al. Granulocyte colony-stimulating fac-tors as prophylaxis against febrile neutropenia[J]. Support Care Cancer, 2015, 23(2):547-559. DOI PMID
[6]	黄家良, 夏坤健, 郭伟, 等. 三阴性乳腺癌化疗致重度骨髓抑制的危险因素分析及其预测模型的构建[J]. 中山大学学报(医学科学版), 2023, 44(5):886-892.
	Huang JL, Xia KJ, Guo W, et al. Risk factors and predictive model for severe myelosuppression due to chemotherapy in triple-negative breast cancer[J]. J Sun Yat Sen Univ Med Sci, 2023, 44(5):886-892.
[7]	黄青梅, 耿朝辉, 吴傅蕾, 等. 乳腺癌患者化疗期间症状群特征及预测指标的研究[J]. 中华护理杂志, 2020, 55(9):1297-1303. DOI URL
	Huang QM, Geng ZH, Wu FL, et al. Study on differential characters of symptom clusters and predictors of breast cancer patients during chemotherapy[J]. Chin J Nurs, 2020, 55(9):1297-1303. DOI URL
[8]	张男, 陆艳, 耿朝辉, 等. 乳腺癌患者化疗期症状困扰人群异质性特征及其影响因素研究[J]. 重庆医学, 2022, 51(22):3875-3879.
	Zhang N, Lu Y, Geng ZH, et al. Heterogeneity characteristics among distress population with symptom during chemotherapy in patients with breast cancer and its influencing factors[J]. Chongqing Med, 2022, 51(22):3875-3879.
[9]	王孟成. 潜变量建模与Mplus应用[M]. 重庆: 重庆大学出版社, 2014.
	Wang MC. Latent variable modeling and Mplus application[M]. Chongqing: Chongqing University Press, 2014.
[10]	何丽, 胡露红, 王玮荻, 等. 乳腺癌化疗患者自我倡权能力与症状负担的相关性[J]. 现代临床护理, 2024, 23(1):1-7.
	He L, Hu LH, Wang WD, et al. Correlations between self-advocacy and symptom burden of breast cancer patients undergoing chemotherapy[J]. Mod Clin Nurs, 2024, 23(1):1-7.
[11]	Wang XS, Wang Y, Guo H, et al. Chinese version of the M. D. Anderson Symptom Inventory:validation and application of symptom measurement in cancer patients[J]. Cancer, 2004, 101(8):1890-1901.
[12]	吴傅蕾, 袁长蓉, 杨瑒, 等. 乳腺癌患者化疗期症状群困扰风险预测模型的构建与评价[J]. 中华护理杂志, 2023, 58(6):676-682. DOI URL
	Wu FL, Yuan CR, Yang C, et al. Development and evaluation of a risk predictive model for high level of self-reported symptom cluster distress in breast cancer patients undergoing chemotherapy[J]. Chin J Nurs, 2023, 58(6):676-682. DOI URL
[13]	周浩, 龙立荣. 共同方法偏差的统计检验与控制方法[J]. 心理科学进展, 2004, 12(6):942-950.
	Zhou H, Long LR. Statistical remedies for common method biases[J]. Adv Psychol Sci, 2004, 12(6):942-950.
[14]	栗晓坤, 刘瑞云, 霍静. 乳腺癌病人症状群与生活质量的相关性分析[J]. 护理研究, 2021, 35(12):2248-2250.
	Li XK, Liu RY, Huo J. Correlation analysis between symptom cluster and quality of life in breast cancer patients[J]. Chin Nurs Res, 2021, 35(12):2248-2250.
[15]	袁书琪, 王园园, 贾凌莹, 等. 癌因性疲乏患者瑜伽运动管理的最佳证据总结[J]. 中华护理杂志, 2023, 58(1):91-97. DOI URL
	Yuan SQ, Wang YY, Jia LY, et al. Evidence summary of yoga management for patients with cancer-related fatigue[J]. Chin J Nurs, 2023, 58(1):91-97. DOI URL
[16]	胡辉, 吴芳, 朱建华. 磁珠耳穴疗法合中医情志护理对乳腺癌患者化疗后睡眠及生活质量的影响[J]. 湖南中医杂志, 2020, 36(11):114-115,149.
	Hu H, Wu F, Zhu JH. Effect of magnetic bead auricular point therapy combined with traditional Chinese medicine emotional nursing on sleep and quality of life of breast cancer patients after chemotherapy[J]. Hunan J Tradit Chin Med, 2020, 36(11):114-115,149.
[17]	Li N, Hou L, Li S. Distinct subgroups of patients with lung cancer receiving chemotherapy:a Latent transition analysis[J]. Front Oncol, 2020, 10:522407.
[18]	王昊天, 蔡汶润, 罗伟, 等. 双侧原发性乳腺癌年轻患者临床特征与诊治探讨[J]. 中华肿瘤防治杂志, 2016, 23(10):652-656.
	Wang HT, Cai WR, Luo W, et al. Clinicopathological analysis and treatment of young patients with bilateral primary breast cancer[J]. Chin J Cancer Prev Treat, 2016, 23(10):652-656.
[19]	Arikan Dönmez A, Kuru Alici N, Borman P. Lived experiences for supportive care needs of women with breast cancer-related lymphedema:a phenomenological study[J]. Clin Nurs Res, 2021, 30(6):799-808.
[20]	王正珍, 王娟, 张献博, 等. 体力活动/运动与癌症防治:研究与应用[J]. 成都体育学院学报, 2022, 48(6):1-7,23.
	Wang ZZ, Wang J, Zhang XB, et al. Physical activity/exercise and cancer prevention and treatment[J]. Chengdu Sport Univ, 2022, 48(6):1-7,23.
[21]	Al Maqbali M. Sleep disturbance among Arabic breast cancer survivors[J]. Support Care Cancer, 2021, 29(9):5179-5186. DOI PMID
[22]	朱文敏, 魏小龙. 非药物干预方法对乳腺癌患者康复效果的网状Meta分析[J]. 中华护理杂志, 2020, 55(6):862-867. DOI URL
	Zhu WM, Wei XL. A comparative study on the rehabilitation effects of non-pharmacological interventions in patients with breast cancer:a network meta-analysis[J]. Chin J Nurs, 2020, 55(6):862-867.