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【摘要】 目的 探讨宫颈癌放射治疗患者的焦虑状况，并分析相关影响因素。 方法 采用Zung焦虑自评量表（self-rating anxiety scale，SAS）及自行设计的多项目问卷调查158例宫颈癌放射治疗患者，对资料完整的125份进行统计分析。 结果 宫颈癌患者放射治疗前期SAS≥50分59例，占47.2%;放射治疗中期SAS≥50分25例，占20%;放射治疗后期SAS≥50分77例，占61.6%。多重比较LSD法分析结果为放射治疗前与放射治疗中SAS评分差异有显著性（P<0.05）。一元线性回归分析提示影响宫颈癌放射治疗患者焦虑症状的因素有无故害怕、发疯感、心悸、恶梦、癌症分期、文化程度、经济负担和疼痛;多元逐步回归分析结果表明发疯感、心跳加速是影响宫颈癌放射治疗患者焦虑症状的重要因素。 结论 焦虑是宫颈癌放射治疗患者普遍存在的症状，并受多种因素影响。因此，在放射治疗过程中应有针对性地辅助个体心理干预措施以缓解患者的焦虑症状。
关键词 焦虑 宫颈癌 放射疗法
Clinical investigation of anxiety in the patients with cervical cancer receiving radiotherapy
Zhang Ruimei，Zhou Fuling，Shao Yindi，et al.
Buji People's Hospital of Longgang District Shenzhen City，Longgang518112.
【Abstract】 Objective To research anxiety symptoms in the patients with cervical cancer（CC）during radio-therapy，and analyze correlative factors.Methods Self-rating anxiety scales（SAS）and multiple items question-naires were given to the voluntary158hospitalized patients with CC，each patient was required to complete those pa-pers，125cases were completed and the data was analyzed with SPSS10.0.Results Score proportion of SAS（SAS≥50）was different during the whole radiotherapy procedure，accounting for47.2%before radiotherapy，20%in metaphase and61.60%in anaphase.LSD clarified anxiety had significant difference between prophase and metaphase（P<0.05）.The tendency of anxiety symptoms in patients with CC was best displayed by Cubic model.Linear Re-gression found that scare，insane feeling，palpitation，frequent nightmare，cancer staging，culture degree，economic burden and pain correlated with anxiety symptoms of the patients with CC.However，a step-wise regression showed that insane feeling and palpitation were the most important factors.Conclusion Anxiety is widespread and is affected by multiple complex factors in patients with CC.Therefore，it is necessary to aim directly at assisting individual psycho-intervention to the patients with CC，which is useful for improving quality of life and rolonging survival.
Key words anxiety cervical cancer radiotherapy
It is well known that anxiety is one of the psychological fea-tures in cancer patients and has close relationship with occurrence，development and prognosis of cancer.Psychological response to possible death，exterior damage and disability can be serious in terms of cancer patients.Moreover，it is a continuous phase from normal fear to high anxiety.We also found anxiety is common in patients with cervical cancer（CC），but there are fewreports about anxiety in patients receiving radiotherapy.Here we had carried out self-rating anxiety scale（SAS）and multiple items questionnaires to analyze statistically anxiety and correlative factors.
1 MATERIALS AND METHODS
1.1 Investigating objects 125cases of patients with CC from8，2001to8，2001were verified by pathological section.They had no psychological disease history.Average age was47.40±10.68，19cases were27～35，35cases were36～45，54cases were46～55，17cases above55;culture degree:76cases were in or below ele-mentary school，49cases in middle school;course:13cases were within3months，35cases were3～6months，38cases were6～12months，25cases were above12months，14cases were above24months;cancer stage:9cases were inⅠphase，59cases were inⅡphase，53cases were inⅢphase，4cases were inⅥphase;loca-tion:21cases lived in city，104cases in country;3cases had posi-tive tumor family history;92cases had cacer pain，account for73.6%.The mean value of NRS was5.07±1.61.
1.2 SAS zung SAS（1971）includes20items and four grades.Researchers caculate SAS statistical index and evaluate standard score.Total scores≥50suggest anxiety symptom.Higher scores mean heavier symptoms.
1.3 Multiple items questionnaires multiple items questionnaires include social population data（such as age，culture degree，loca-tion，economical condition，etc.）、cancer progress、clinical symptom（such as vaginal hemorrhage and cancer pain）、patholog-ical grades、clinical staging、squamous cell carcinoma antigen（SCC-Ag）etc.we studied the correlative factors influcing anxiety symptom in patients by these data.Numeracial rating scale（NRS）was used to evaluate pain.Numbers from0to10suggest painless and intense pain.Patients sign the number that showing his pain degree.
1.4 Data collection Radiotherapy lasted for6～7weeks.Doc-tors sent out questionnaires and explained it to patients before ther-apy until they understood every item and knewhowto sign it，then，patients finished it in quiet place.Investigation progress was indi-vidual excluding others affection.If patients couldn't sign the table because of low education or disease，the family member or doctor could sign it after consulting patients.Sign the SAS again in metaphase radiotherapy（3～4wk）and anaphase（2days after therapy）.
1.5 Statistical analysis we sent out158questionnaires and col-lected125usable papers.Reclaiming rate is79.11%.The initial data was disposed by SPSS10.0statistical package.The methods mainly were Explore、Two-Way ANOVA、Curve Estimation and Linear Regression.
2 RESULTS
2.1 Anxiety symptom and multiple comparison
2.1.1 Anxiety before radiotherapy SAS standard scores of total125cases were30～76.25，average score was48.28±10.92，and Score proportion of59cases（SAS≥50）was47.2%.Distribution of SAS standard scores was analyzed by Explore（fig1，and2）fig1 Normal Q-Q plot of anxiety fig2 Detrended Normal Q-Q plot of anxiety
2.1.2 multiple comparison SAS scores of125patients in metaphase radiotherapy were32.50～55.Average score was40.83±7.73.25cases（SAS≥50）were about20%of the patients;SAS scores after radiotherapy were32.50～63.75.Average score was47.98±11.31.77cases were above50，which were about61.60%of the patients.Multiple Comparisons results:itwas significantly decreased between prophase and metaphase（P<0.05）.But there was no significant difference between anterior and anaphase、metaphase and anaphase（P<0.05，table1）。
table1 Multiple Comparisons of SAS scores in prophase，metaphase and anaphase radiotherapy（略）
Notes:compared to radiotherapy（I） * P<0.05
2.1.3 Curve Estimation of anxiety during radiotherapy The aim of Curve Estimation is to observe trend of various anxiety as the time passed.Anxiety symptom was heavier before radiotherapy，a little better in metaphase but heavier again in anaphase.In multi-Curve Estimation the square of Cubic model's correlation coeffi-cient was the biggest，therefore，Cubic model is the best model to select.
2.2 Factors influencing anxiety There were many factors influ-encing anxiety in terms of patients receiving radiotherapy.Accord-ing to the data in prophase，Linear Regression showed the factors were gratuitous scare，insane，palpitation，constant nightmare，can-cer staging，culture，economic burden and pain.But the Step-Wise Regression suggested that the most important factors were in-sane and palpitation（table2）。
Table2 Result of multi-variable analysis with Step-Wise Regression（略）
Notes: * P<0.05
3 DISCUSSION
CC is the malignant tumor which threats women's health severely.As a major methods，Radiotherapy can inhibit prolifera-tion of carcinoma because radiation can inhibit proliferating cell nuclear antigen（PCNA）in cancer cell and induce expression of PCNA in interstitial cell ［1］ .Aged people are the major group，due to tumor is a big stimulation to the patients，If they receive a strange therapy following with the subsequent side effects，they will present severe anxiety symptom ［2～4］ .Investigation of1158norm were29.8in china，and46can be considered as the up lim-it of norm mean ［1］ .Therefore，in this study we can say that anxi-ety symptom is commonly seen and is serious to the extent during radiotherapy.
Anxiety symptom varies with progress，diagnosis and thera-py ［5］ .Major symptom such as vaginal hemorrhage and pain can be controlled quickly in the beginning of radiotherapy.In metaphase，with the relieving of disease，patients desire to live and so does anxiety.But in anaphase patients worry about the side effects of radiotherapy and tumor relapse in the following life.Therefore，if they have a little uncomfortable feel theywill doubt the therapy and find newmethods constantly.They get dyssomnia and nightmare so frequent that SAS increase again，which identify withwhat von Es-sen L reported ［6］ .The resulit of Multiple Comparisons LSD and Cubic model of anxiety manifest the changing trend accurately.
Research of SAS questionnaire shows insane and palpitation are the most important factors influencing anxiety.Loss of good health，inattention，bad memories，hebetude，dizziness，tired-ness，and worries about disease，all these feelings can aggravate insane symptom.Patients are in stress.Sympathetic nerve acts ac-tively.Cardiovascular system symptom such as palpitation is com-monly seen which represent increased heartbeat.Furthermore，be-cause of extremely fear to tumor，patients always in the situation of gratuitous scare，dyssomnia and nightmare，which resulting in the blue mood and bad mental state at day.In multiple items ques-tionnaires，pain is an important physical and psychological stimu-lus.It can induce and aggravate sharpen distress.Chen ML ［7］ has reported pain is correlative factor of anxiety in cancer patients.
Pain is one of the factors affecting anxiety symptom in CC patients in this study.Due to long-term course，Terminal patients have obvious symptom and they suffer from repeatedly psychological stimulus that they lost confidence，therefore，they immerse in deep anxiety.As for patients without enough money，they are over burdened after several therapies.Anxiety deepens because it is difficult for them to afford hospitalization.Patients with higher edu-cation know self-disease very well，and they have easily became anxiety because of autosuggestion of negative response.Thus，we should give immediate psycho-intervention to patients to relieve anxiety from self-disease in clinical practice ［2，4，8］ .
In a word，anxiety is one kind of emotional response caused by bad stimulus.To research anxiety occurrence and correlative factors in patients with CC receiving radiotherapy，which will re-dound to aim directly at use psychotherapy individually，may be important in improving living quality and prolonging life.
参考文献
1 魏丽春，石梅，郭燕，等.放射治疗对人宫颈癌组织的增殖细胞核抗原表达的影响.第四军医大学学报，2001，22（4）:337-339.
2 Singer S，Schwarz R.Psychosocial after care of patients with endometrial or cervical cancer.Zentralbl Gynakol，2002，124（1）:64-70.
3 Harrison R，Dey P，Slevin NJ，et al.Randomized controlled trial to assess the effectiveness of a videotape about radiotherapy.Br J Cancer，2001，84（1）:8-10.
4 黄颖，李武平，付菊芳，等.晚期癌症患者心理健康教育的实施.第四军医大学学报，2001，22（Suppl）:156.
5 Montazeri A，Harirchi I，Vahdani M，et al.Anxiety and depression in I-ranian breast cancer patients before and after diagnosis.Eur J Cancer Care，2000，9（3）:151-157.
6 von Essen L，Enskar K，Kreuger A，et al.Self-esteem，depression and anxiety among Swedish children and adolescents on and off cancer treatment.Acta Paediatr，2000，89（2）:229-236.
7 Chen ML，Chang HK，Yeh CH.Anxiety and depression in Taiwanese cancer patients with and without pain.J AdvNurs，2000，32（4）:944-951.
8 Petersen RW，Quinlivan JA.Preventing anxiety and depression in gy-naecological cancer:a randomized controlled trial.BJOG，2002，109（4）:386-394.
（编辑建 伟）
作者单位:518112广东省深圳市龙岗区布吉人民医院
710061西安交大第一医院肿瘤放疗科（△ 通讯作者）