CAJ | 학술논문

目的：评估综合性心理干预对化疗期乳腺癌患者焦虑和抑郁的作用，并探讨化疗前后焦虑和抑郁对乳腺癌患者细胞免疫功能的影响。方法采用自行设计好问卷、Herth希望量表、汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）对81例已婚女性乳腺癌患者进行调查和测评，将符合纳入标准的64例抑郁、焦虑共病患者（HAMD评分大于或等于8且 HAMA评分大于或等于7分）随机分为干预组和对照组。流式细胞术检测患者外周静脉血 T 细胞亚群（CD3＋、CD4＋、CD8＋、CD4＋/CD8＋）及自然杀伤细胞（NK细胞）。结果化疗后，干预组比对照组Herth评分增加37．19％，HAMD评分减少36．01％，差异有统计学意义（P＜0．01）；化疗前与化疗后比较，干预组 Herth评分增加了（12．57±4．57）分，HAMD和 HAMA评分分别下降了（9．32±1．86）分和（4．35±1．15）分，且差异均有统计学意义（ P＜0．01）。与对照组比较，干预组化疗前后CD3＋、CD4＋、CD4＋/CD8＋和NK细胞差值分别增加2．10±1．63、1．51±1．02、0．05±0．02和0．78±0．52，差异均有统计学意义（P＜0．01），HAMD评分与CD4＋/CD8＋呈负相关（r＝-0．554）。结论乳腺癌患者细胞免疫功能减退可能与焦虑合并抑郁程度相关，综合性心理干预模式可改善化疗期乳腺癌患者抑郁、焦虑情绪。
목적：평고종합성심리간예대화료기유선암환자초필화억욱적작용，병탐토화료전후초필화억욱대유선암환자세포면역공능적영향。방법채용자행설계호문권、Herth희망량표、한밀이돈초필량표（HAMA）화한밀이돈억욱량표（HAMD）대81례이혼녀성유선암환자진행조사화측평，장부합납입표준적64례억욱、초필공병환자（HAMD평분대우혹등우8차 HAMA평분대우혹등우7분）수궤분위간예조화대조조。류식세포술검측환자외주정맥혈 T 세포아군（CD3＋、CD4＋、CD8＋、CD4＋/CD8＋）급자연살상세포（NK세포）。결과화료후，간예조비대조조Herth평분증가37．19％，HAMD평분감소36．01％，차이유통계학의의（P＜0．01）；화료전여화료후비교，간예조 Herth평분증가료（12．57±4．57）분，HAMD화 HAMA평분분별하강료（9．32±1．86）분화（4．35±1．15）분，차차이균유통계학의의（ P＜0．01）。여대조조비교，간예조화료전후CD3＋、CD4＋、CD4＋/CD8＋화NK세포차치분별증가2．10±1．63、1．51±1．02、0．05±0．02화0．78±0．52，차이균유통계학의의（P＜0．01），HAMD평분여CD4＋/CD8＋정부상관（r＝-0．554）。결론유선암환자세포면역공능감퇴가능여초필합병억욱정도상관，종합성심리간예모식가개선화료기유선암환자억욱、초필정서。
Objective To evaluate the effects of the comprehensive psychological intervention on anxiety and depression of the patients with breast cancer during chemotherapy ,and to explore the influence of depression and anxiety before and after chemother-apy on the cellular immune function .Methods A total of 81 married female patients with breast cancer were surveyed and assessed with self-designed questionnaire ,the Herth Hope Scale ,the Hamilton Depression Scale(HAMD) and the Hamilton Anxiety Scale (HAMA) .64 cases of breast cancer with depression and anxiety according with the included standards (HAMD scores ≥8 and HA-MA scores ≥7) were randomly divided into the intervention group(n=32) and the control group(n=32) .The levels of T lympho-cyte subsets(CD3+ ,CD4+ ,CD8+ ,CD4+ /CD8+ ) and the natural killing(NK) cells in peripheral venous blood were determined by the flow cytometry(FCM) .Results The Herth scores after chemotherapy in the intervention group were increased by 37 .19% than that of the control group ,while the HAMD scores were decreased by 36 .01% compared with the control group ,the differences be-tween them showing statistical significance (P<0 .01) .In the comparison between before and after chemotherapy ,the Herth scores in the intervention group were increased by 12 .57 ± 4 .57 ,while the HAMD and HAMA scores were declined by 9 .32 ± 1 .86 and 4 .35 ± 1 .15 respectively ,the differences showed the statistical significance (P< 0 .01) .Compared with the control group ,CD3+ , CD4+ ,CD4+ /CD8+ ratio and NK cells before and after chemotherapy in the intervention group were increased by 2 .10 ± 1 .63 , 1 .51 ± 1 .02 ,0 .05 ± 0 .02 and 0 .78 ± 0 .52 correspondingly ,the differences among them had statistical significance(P<0 .001) .The HAMD scores were negatively correlated with the CD4+ /CD8+ ratio(r= -0 .554) .Conclusion The cellular immune hypofunction in the patients with breast cancer is probably related with anxiety and degree of depression .The comprehensive psychological inter-vention model can improve the anxiety and depression mood during chemotherapy .