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Received:September 02, 2021 Published Online:April 20, 2022
Received:September 02, 2021 Published Online:April 20, 2022
中文摘要: 目的 探讨妇科恶性肿瘤患者心理障碍影响因素并构建预测模型。
方法 前瞻性选取唐山市妇幼保健院2018年1月至2021年4月314例妇科恶性肿瘤患者作为调查对象，采用自制一般资料调查表进行问卷调查，根据明尼苏达多相人格测试（MMPI）分为心理障碍组（MMPI≥60分）和非心理障碍组（MMPI＜60分），比较两组一般资料。应用Logistic回归分析妇科恶性肿瘤患者心理障碍影响的因素，随机选取69.75%（219例）的病例作为训练集，30.25%（95例）作为测试集，R软件基于训练集建立列线图预测模型，并在测试集评估模型效能。结果 剔除无效问卷3份（训练集1份、测试集2份），最终获得有效问卷311份，有效回收率为99.04%；训练集中共纳入218例，心理障碍组78例（35.78%），非心理障碍组140例（64.22%）。两组受教育年限、放疗和/或化疗次数、睡眠质量评分、肿瘤转移、生育需求、社会支持评定量表（SSRS）评分、疼痛评分对比差异均有统计学意义（P＜0.05，P＜0.01）；多因素Logistic分析显示，放疗和/或化疗次数（OR=2.484）、睡眠质量评分（OR=1.257）、生育需求（OR=4.932）、肿瘤转移（OR=2.327）为妇科恶性肿瘤患者心理障碍发生的独立危险因素（P<0.01，P<0.05），SSRS评分（OR=0.568）为保护因素（P<0.01）；上述因素预测妇科恶性肿瘤患者心理障碍相关因素的一致性指数为0.885（95%CI：0.838～0.933）。外部验证显示模型预测心理障碍敏感性为93.75%，特异性98.36%，准确率96.77%。
结论 放疗和/或化疗次数、睡眠质量、生育需求、肿瘤转移是妇科恶性肿瘤患者心理障碍发生的独立危险因素，社会支持是其保护因素。
Abstract:Objective To explore the influencing factors of psychological disorders in patients with gynecological malignant tumors and construct a prediction model for it. Methods A total of 314 patients with gynecological malignant tumors in Tangshan Maternal and Child Health Hospital from January 2018 to April 2021 were prospectively selected as the subjects for self-made general information questionnaire. According to the Minnesota Multiphasic Personality Inventory （MMPI） test, they were divided into mental disorder group （MMPI≥60 points） and non-mental disorder group （MMPI＜60 points）. Logistic regression analysis was used to analyze the related factors affecting the psychological disorders of patients with gynecological malignant tumors. All patients were randomly assigned to the training set （n=219,69.75%） and the test set（n=95,30.25%）. The nomogram prediction model based on the training set was established by R software, and the performance of the model was evaluated in the test set. Results A total of 311 valid questionnaires were obtained（99.04%）, excluding 3 invalid questionnaires （1 in training set and 2 in test sets）. Of 218 cases in training set, there were 78 cases （35.78%） in mental disorder group and 140 cases(64.22%) in non-mental disorder group. There were significant differences between two groups in education level, times of radiotherapy and/or chemotherapy, sleep quality score, tumor metastasis, fertility need, social support rating scale(SSRS) and pain （P＜0.05, P＜0.01）. Multivariate logistic analysis showed that the number of radio therapy and/or chemotherapy（OR=2.484）, sleep quality score （OR=1.257）, fertility needs （OR=4.932） and tumor metastasis （OR=2.327） were the independent risk factors and SSRS （OR=0.568） was the protective factor （P<0.05，P<0.01）. The conformity index of above-mentioned factors predicting the psychological disorders in patients with gynecological malignant tumors was 0.885 （95% CI： 0.838-0.933）. External verification showed that the sensitivity, the specificity and the accuracy rate of the model in predicting the psychological disorders were 93.75%, 98.36% and 96.77%, respectively.
Conclusion In the patients with gynecological malignancies, the frequency of radio therapy and/or chemotherapy, sleep quality, fertility needs and tumor metastasis are the independent risk factors for the occurrence of psychological disorders,and social support is a protective factor for the psychological well-being.
keywords: Gynecological malignant tumors Psychological disorder Social support Fertility need Prediction model
文章编号： 中图分类号：R737.3 R395 文献标志码：B
基金项目:河北省医学科学研究课题计划（20191539）
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