上海交通大学学报（医学版）

上海交通大学学报（医学版） ›› 2023, Vol. 43 ›› Issue (9): 1186-1193.doi: 10.3969/j.issn.1674-8115.2023.09.013

• 临床护理专题 • 上一篇    

前列腺癌患者内分泌治疗相关不良反应的潜在剖面分析

朱涵菁1(), 殷弘凡2, 尤思洁1, 杨艳1,2()   

  1. 1.上海交通大学医学院附属仁济医院泌尿科，上海 200127
    2.上海交通大学护理学院，上海 200025
  • 收稿日期:2023-05-24 接受日期:2023-06-19 出版日期:2023-09-28 发布日期:2023-09-28
  • 通讯作者: 杨艳 E-mail:zhu_hanjing@163.com;yang2021@sjtu.edu.cn
  • 作者简介:朱涵菁（1998—），女，硕士生；电子信箱：zhu_hanjing@163.com。
  • 基金资助:
    国家自然科学基金(72174120);上海交通大学医学院护理学科人才队伍建设项目;上海高水平地方高校创新团队(ZDCX20212800)

Latent profile analysis of adverse effects associated with endocrine therapy in prostate cancer patients based on the theory of unpleasant symptoms

ZHU Hanjing1(), YIN Hongfan2, YOU Sijie1, YANG Yan1,2()   

  1. 1.Urology Department, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200127, China
    2.Shanghai Jiao Tong University School of Nursing, Shanghai 200025, China
  • Received:2023-05-24 Accepted:2023-06-19 Online:2023-09-28 Published:2023-09-28
  • Contact: YANG Yan E-mail:zhu_hanjing@163.com;yang2021@sjtu.edu.cn
  • Supported by:
    National Natural Science Foundation of China(72174120);Shanghai Jiao Tong University School of Medicine: Nursing Development Program;Innovation Research Team of High-level Local Universities in Shanghai(ZDCX20212800)

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摘要：

目的·基于不悦症状理论，调查前列腺癌患者内分泌治疗相关不良反应现状，并识别不同潜在类别及人群特异性。方法·采用便利抽样法，选取2022年6—9月上海交通大学医学院附属仁济医院泌尿科的274例前列腺癌内分泌治疗患者。采用基本信息调查表、简体中文版老年男性症状量表、中文版Mishel 疾病不确定感量表、领悟社会支持量表、中文版疾病心理社会适应量表对内分泌治疗相关不良反应进行调查，并对结果进行潜在剖面分析。采用t检验和方差分析各亚组中人群的特征，采用LSD法进行两两间的多重比较，采用多元Logistic回归探索前列腺癌患者内分泌治疗相关不良反应的影响因素，使用Mplus 8.3进行潜在剖面分析，识别前列腺癌患者内分泌治疗相关不良反应的潜在分类。结果·前列腺癌患者内分泌治疗相关不良反应可分为轻症状组（n=96，35.0%）、中等症状组（n=111，40.5%）及重症状组（n=67，24.5%）3个类别。相比于轻症状组患者，中等症状组患者在心理社会适应（OR=1.038，95%CI 1.018~1.060，P=0.000）和是否进行基因检测（OR=0.336，95%CI 0.129~0.879，P=0.026）因素上具有明显差异。相比于轻症状组患者，重症状组患者在心理社会适应（OR=1.027，95%CI 1.003~1.051，P=0.024）、疾病不确定感（OR=1.021，95%CI 1.005~1.038，P=0.011）、M期（OR=0.354，95%CI 0.136~0.924，P=0.034）、前列腺特异性抗原（prostate specific antigen，PSA）（OR=0.142，95%CI 0.042~0.480，P=0.002；OR=0.275，95%CI 0.083~0.914，P=0.035）因素上具有明显差异。结论·前列腺癌内分泌治疗相关不良反应发生率高，患者可根据不良反应分为3个潜在类别，不同类别的前列腺癌内分泌治疗患者在疾病转移、PSA水平、是否进行基因检测、疾病不确定感和心理社会适应状况上存在显著差异。医护人员应评估前列腺癌内分泌治疗患者不同的人口社会学背景、疾病特异性和心理社会状态，顺应精准医学背景，根据患者的特质提供针对性的支持，帮助他们掌握自我管理技能并积极应对治疗的不良反应。

关键词: 前列腺癌, 内分泌治疗, 不良反应, 不悦症状理论, 潜在剖面分析

Abstract:

Objective ·Based on the theory of unpleasant symptoms, to investigate the current status of adverse effects associated with endocrine therapy in prostate cancer patients, and identify the difference of population specificity in each latent category. Methods ·From June 2022 to September 2022, 274 patients with endocrine therapy for prostate cancer in the Urology Department of Renji Hospital, Shanghai Jiao Tong University School of Medicine were selected by convenience sampling method. Adverse reactions associated with endocrine therapy were investigated by basic information questionnaire and simplified Chinese version of the aging male′s symptoms scale. Latent profile analysis was conducted and the differences of population characteristics among categories were assessed based on t-test, variance analysis and multiple Logistic regression. Perform latent profile analysis was performed by using Mplus 8.3 to identify latent classes of endocrine treatment-related adverse events in prostate cancer patients. Results ·Adverse reactions associated with endocrine therapy in patients with prostate cancer could be divided into three groups: mild-symptom group (n=96, 35.0%), moderate-symptom group (n=111, 40.5%) and severe-symptom group (n=67,24.5%). Compared to patients with mild symptoms, those in the moderate-symptom group had significant differences in psychosocial adaptation (OR=1.038, 95%CI 1.018?1.060, P=0.000), and whether genetic detection was performed (OR=0.336, 95%CI 0.129?0.879, P=0.026). Compared to patients with mild symptoms, those in the severe-symptom group had significant differences in psychosocial adaptation (OR=1.027, 95%CI 1.003?1.051, P=0.024), disease uncertainty (OR=1.021, 95%CI 1.005?1.038, P=0.011), M stage (OR=0.354, 95%CI 0.136?0.924, P=0.034), and prostate specific antigen (PSA) (OR=0.142, 95%CI 0.042?0.480, P=0.002; OR=0.275, 95%CI 0.083?0.914, P=0.035). Conclusion ·The incidence of adverse reactions associated with endocrine therapy for prostate cancer is high. Adverse effects associated with endocrine therapy in prostate cancer patients can be classified into three categories. There are significant differences in disease metastasis, PSA levels, genetic testing, disease uncertainty, and psychosocial adaptation among prostate cancer patients receiving endocrine therapy in different categories. Healthcare professionals should assess the diverse sociodemographic background, disease-specific factors, and psychosocial status of prostate cancer patients receiving endocrine therapy, and provide targeted support according to their characteristics to help them acquire self-management skills and cope with adverse treatment effects proactively, in line with the precision medicine framework.

Key words: prostatic neoplasms, endocrine therapy, adverse reaction, theory of unpleasant symptoms, latent profile analysis

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