恶性肿瘤患者及家属焦虑抑郁状态与细胞免疫功能相关性的临床研究

Clinical Study on the Correlation between Anxiety, Depression and Cellular Immune Function in Patients with Malignant Tumor and Their Family Members

摘要: 目的：探讨化疗期间恶性肿瘤患者及家属焦虑抑郁状态与患者细胞免疫功能的关联性及交互影响。方法：采用横断面研究设计，基于效应量估算样本量后纳入60例化疗患者及60名家属，应用焦虑自评量表(SAS)和抑郁自评量表(SDS)评估心理状态，流式细胞术检测T淋巴细胞亚群及NK细胞活性。经正态性与方差齐性验证后，采用独立样本t检验、χ²检验、Spearman秩相关、logistic回归及多元线性回归分析数据。结果：患者焦虑检出率41.7% (25/60)，抑郁检出率46.7% (28/60)；家属焦虑、抑郁检出率分别为36.7% (22/60)和35.0% (21/60)，患者SAS评分每增加10分，家属焦虑风险升高1.98倍(OR = 1.98, 95% CI: 1.22~3.21, P = 0.006)。焦虑抑郁状态患者CD4⁺细胞比例显著降低(30.1% vs 35.4%, P < 0.001)，NK细胞活性下降(38.5% vs 45.7%, P < 0.001)。Spearman秩相关显示SDS评分与CD4⁺呈负相关(rₛ = −0.45, P < 0.01)，与NK活性负相关(rₛ = −0.40, P < 0.01)。多元线性回归证实SDS评分是CD4⁺细胞比例降低的独立相关因素(β = −0.32, P = 0.002)。结论：化疗期间恶性肿瘤患者及家属焦虑抑郁状态与细胞免疫功能抑制显著相关，心理干预需转向家庭整体支持模式。

Abstract: Objective: To explore the correlation and interaction between the anxiety and depression of cancer patients and their family members and the cellular immune function of cancer patients during chemotherapy. Methods: In this cross-sectional study, 60 chemotherapy patients and 60 family members were enrolled. Self-rating anxiety scale (SAS) and self-rating depression scale (SDS) were used to evaluate their psychological status. After normality and homogeneity of variance were verified, independent sample t test, χ² test, Spearman rank correlation, logistic regression and multiple linear regression were used to analyze the data. Results: The detection rates of anxiety and depression were 41.7% (25/60) and 46.7% (28/60), respectively. The detection rates of anxiety and depression in family members were 36.7% (22/60) and 35.0% (21/60), respectively. For every 10 points increase in SAS score of patients, the risk of anxiety in family members increased by 1.98 times (OR = 1.98, 95% CI: 1.22~3.21, P = 0.006). The percentage of CD4⁺ cells (30.1% vs 35.4%, P < 0.001) and NK cell activity (38.5% vs 45.7%, P < 0.001) were significantly decreased in patients with anxiety or depression. The Spearman rank agreement showed that SDS scores were negatively correlated with CD4⁺ (rₛ = −0.45, P < 0.01) and NK activity (rₛ = −0.40, P < 0.01). Multiple linear regression analysis showed that SDS score was an independent predictor of CD4⁺ cell percentage reduction (β = −0.32, P = 0.002). Conclusions: The anxiety and depression of patients with malignant tumor and their family members during chemotherapy are significantly related to the suppression of cellular immune function. Psychological intervention should be shifted to the holistic family support model.