鼻咽癌患者围放疗期症状负担类别的潜在转变及影响因素分析

doi:10.3761/j.issn.0254-1769.2026.04.008

摘要/Abstract

摘要：

目的基于潜在转变分析探讨鼻咽癌患者围放疗期症状负担的潜在类别及个体在类别间的转变模式，并分析影响转变的相关因素。方法便利选取2024年10月至2025年9月浙江省某三级甲等医院240例头颈放疗科的鼻咽癌患者作为调查对象，于放疗前、放疗中期及放疗结束时采用安德森症状评估量表-头颈癌模块评估症状负担。通过潜在剖面分析识别症状负担亚组，并基于最优模型进行潜在转变分析，采用二元Logistic回归探讨其影响因素。结果共233例鼻咽癌患者完成3次调查，围放疗期患者的症状负担可分为低负担型与高负担型两类。潜在转变分析识别出8种转变模式，其中在各相邻阶段分别有41.10%和42.50%的低负担型患者转为高负担型，而大部分高负担型患者维持原状态。二元Logistic回归分析显示，放疗前中期螺旋断层放疗和BMI超重有助于维持低负担型，放疗中后期有子女者症状加重风险较低，而本科或大专以上文化程度和家族肿瘤史者更易从高负担型向低负担型改善。结论鼻咽癌患者围放疗期症状负担具有异质性和阶段转变性。临床应重视早期筛查与连续监测，结合精准放疗、营养支持、健康教育及社会支持等综合干预，以延缓症状进展，提高患者的生活质量。

关键词: 鼻咽癌, 围放疗期, 症状负担, 潜在转变分析, 影响因素分析, 护理

Abstract:

Objective This study employed latent transition analysis（LTA） to identify the latent classes of symptom burden and the transition patterns among nasopharyngeal carcinoma（NPC） patients during the peri-radiotherapy period，and to explore factors associated with these transitions. Methods This study was conducted involving 240 NPC patients who received radiotherapy at a tertiary hospital in Zhejiang Province between October 2024 and September 2025. Symptom burden was assessed using the Anderson Symptom Assessment Scale-Head and Neck at 3 time points，namely before radiotherapy，mid-radiotherapy，and upon completion of radiotherapy. Latent profile analysis was used to identify subgroups of symptom burden，and LTA based on the optimal model was performed to determine transition pathways between classes. Binary logistic regression was applied to identify factors influencing class transitions. Results A total of 233 NPC patients completed 3 surveys. Totally 2 latent classes of symptom burden were identified，namely a low-burden group and a high-burden group. LTA identified 8 distinct transition patterns. At consecutive stages，41.10% and 42.50% of patients in the low-burden group transitioned to the high-burden group，whereas most patients in the high-burden group remained stable. Logistic regression showed that Tomotherapy and overweight BMI before and during treatment were associated with maintaining a low-burden state. In the later stages of radiotherapy，having children was linked to a lower risk of symptom aggravation，whereas patients with a college-level education or above or a family history of cancer were more likely to transition from the high- to the low-burden class. Conclusion Symptom burden among NPC patients during the peri-radiotherapy period exhibits substantial heterogeneity and dynamic stage-specific transitions. Clinically，emphasis should be placed on early screening and continuous monitoring，alongside comprehensive interventions such as precision radiotherapy，nutritional support，health education，and social support，to mitigate symptom progression and improve patients’ quality of life.

Key words: Nasopharyngeal Carcinoma, Peri-Radiotherapy Period, Symptom Burden, Latent Transition Analysis, Root Cause Analysis, Nursing Care

汪芳莹, 陈雪峰, 贾燕, 吴婉英. 鼻咽癌患者围放疗期症状负担类别的潜在转变及影响因素分析[J]. 中华护理杂志, 2026, 61(4): 490-497.

WANG Fangying, CHEN Xuefeng, JIA Yan, WU Wanying. Subgroups and transition patterns of symptom burden among nasopharyngeal carcinoma patients during the peri-radiotherapy period：a latent transition analysis[J]. Chinese Journal of Nursing, 2026, 61(4): 490-497.

图/表 6

表1 鼻咽癌患者围放疗期症状负担潜在剖面分析（n=233）

Table 1 Latent profile analysis of symptom burden among nasopharyngeal carcinoma patients during the peri-radiotherapy period（n=233）

图1 鼻咽癌患者围放疗期症状负担两类别分布图注：T1为放疗前1 d；T2为放疗中期；T3为放疗结束时。

Figure 1 Distribution of the 2 latent classes of symptom burden among nasopharyngeal carcinoma patients during the peri-radiotherapy period

图2 鼻咽癌患者围放疗期症状负担潜在转变流向图注：T1为放疗前1 d；T2为放疗中期；T3为放疗结束时。

Figure 2 Latent transition flowchart of symptom burden in nasopharyngeal carcinoma patients during the peri-radiotherapy period

表2 症状潜在类别转变的概率情况

Table 2 Probabilities of transitions between latent symptom burden classes

表3 鼻咽癌患者围放疗期症状负担潜在转变的单因素分析[例（百分比，%）]

Table 3 Univariate analysis of latent transitions in symptom burden among nasopharyngeal carcinoma patients during the peri-radiotherapy[case（percentage，%）]

表4 鼻咽癌患者围放疗期症状负担潜在转变的二元Logistic回归分析

Table 4 Binary Logistic regression analysis of latent transitions in symptom burden among nasopharyngeal carcinoma patients during the peri-radiotherapy

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