中晚期结直肠癌患者症状负担的潜在剖面及影响因素研究

doi:10.3761/j.issn.0254-1769.2026.03.011

摘要/Abstract

摘要：

目的探讨中晚期结直肠癌患者在接受抗肿瘤药物治疗期间症状负担的异质性及其影响因素，为优化临床症状管理方案提供参考。方法采用便利抽样法，选取2024年5—9月苏州市某三级甲等医院肿瘤科收治的225例中晚期结直肠癌患者作为调查对象，使用一般资料调查表、一般自我效能感量表、希望水平量表和中文版记忆症状评估量表对其进行调查。通过潜在剖面分析探究中晚期结直肠癌患者症状负担的异质性，并采用无序多分类Logistic回归和决策树分析其影响因素。结果回收有效问卷216份，有效问卷回收率为96.00%。患者的症状负担得分为0.54（0.27，0.79）分，分为低症状负担组（43.98%）、高神经-皮肤症状负担组（25.93%）、高症状负担组（30.09%）3个潜在剖面。无序多分类Logistic回归分析结果显示，性别、有无造口、是否接受免疫治疗、靶向药物种类是中晚期结直肠癌患者症状负担异质性的影响因素；决策树分析结果显示，是否接受免疫治疗、靶向药物种类、BMI分级和性别是其影响因素。结论中晚期结直肠癌患者在接受抗肿瘤药物治疗期间的症状负担存在明显异质性，医护人员应根据相关影响因素，早期识别症状负担较重的患者，制订并实施精准的症状管理方案，以提升患者的生活质量。

关键词: 结直肠癌, 症状负担, 潜在剖面分析, 回归分析, 决策树, 影响因素分析, 护理

Abstract:

Objective To explore the heterogeneity and influencing factors of symptom burden in patients with mid to late-stage colorectal cancer during the period of receiving anti-neoplastic drugs，to optimize the management of clinical symptoms. Methods A cross-sectional study was conducted from May to September 2024 using convenience sampling. A total of 225 patients with mid to late-stage colorectal cancer were recruited from the oncology department of a tertiary hospital in Suzhou. Data were collected using the General Information Questionnaire，Memorial Symptom Assessment Scale（MSAS），General Self-Efficacy Scale（GSES），and Herth Hope Index（HHI）. Latent profile analysis（LPA） was used to analyze heterogeneity of symptom burden，while logistic regression and decision tree analyses were integrated to identify the influencing factors. Results A total of 216 valid questionnaires were collected，and the effective questionnaire recovery rate was 96.00%. The total score of symptom burden was 0.54（0.27，0.79），which could be classified into 3 categories，namely “the group of low symp-tom burden”（43.98%），“the group of high neuro-cutaneous symptom burden”（25.93%），and “the group of high symptom burden”（30.09%）. Gender，colostomy，immunotherapy and different targeted drugs were the influencing factors of symptom burden in the patients by Logistic regression analysis. Immunotherapy，the types of targeted drug，gender and BMI were the influencing factors by decision tree model analysis. Conclusion The symptom burden of the patients with mid to late-stage colorectal cancer receiving anti-neoplastic drugs is significantly heterogeneous. Medical staff should pay attention to the patients with different symptom characteristics. Early assessment of the patients with high risk factors and implementation of precision nursing measures can prevent or reduce symptom burden of the patients.

Key words: Colorectal Cancer, Symptom Burden, Latent Profile Analysis, Regression Analysis, Decision Tree, Root Cause Analysis, Nursing Care

田凤美, 李惠玲, 安清, 王金悦, 谭丽萍, 赵丽爽. 中晚期结直肠癌患者症状负担的潜在剖面及影响因素研究[J]. 中华护理杂志, 2026, 61(3): 368-376.

TIAN Fengmei, LI Huiling, AN Qing, WANG Jinyue, TAN Liping, ZHAO Lishuang. Latent profile analysis and influencing factors of symptom burden in patients with mid to late-stage colorectal cancer[J]. Chinese Journal of Nursing, 2026, 61(3): 368-376.

图/表 5

表1 中晚期结直肠癌患者的一般资料及症状负担潜在剖面的单因素分析结果[例（百分比，%）]

Table 1 Univariate analysis results of general data and symptom burden latent profiles in patients with mid to late-stage colorectal cancer[cases（percentage，%）]

表2 中晚期结直肠癌患者症状负担潜在剖面模型的拟合结果（n=216）

Table 2 Potential profile model of symptom burden in patients with mid to late-stage colorectal cancer（n=216）

图1 中晚期结直肠癌患者症状负担潜在剖面的特征分布注：1为疼痛，2为乏力，3为咳嗽，4为口干，5为昏昏欲睡，6为性功能障碍，7为眩晕，8为体重下降，9为脱发，10为恶心，11为没有食欲，12为腹胀，13为腹泻，14为便秘，15为出汗，16为注意力分散，17为焦虑不安，18为悲伤，19为急躁易怒，20为精神紧张，21为难以入睡，22为手脚麻木，23为皮肤改变，24为皮肤干燥，25为皮肤瘙痒。

Figure 1 Characteristic distribution of potential profile of symptom burden in patients with mid to late-stage colorectal cancer

表3 自变量赋值方式

Table 3 Assignment methods for independent variables

表4 中晚期结直肠癌患者症状负担潜在剖面影响因素的无序多分类Logistic回归分析结果（n=216）

Table 4 Logistic regression analysis of potential profile influencing factors on symptom burden in patients with mid to late-stage colorectal cancer（n=216）

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