目的: 探讨乳腺癌术后患者发生负性心理的影响因素,构建Nomogram模型,并对该模型的预测价值进行验证。方法: 本研究为前瞻性研究,选取2020年1月至2023年12月期间某三甲医院收治的550例乳腺癌术后患者作为研究对象,收集一般资料、心理评估结果、疼痛评分、婚姻状况、人均月收入、是否需要放、化疗、疾病分期等数据,采用Logistic回归分析确定影响乳腺癌术后患者负性心理的影响因素,并利用R软件构建Nomogram模型。结果: 疼痛评分（≥7分）（OR=2.438,95%CI：1.324~4.490）、人均月收入（<3000元）（OR=3.334,95%CI：1.907~5.830）、婚姻状态为未婚（OR=2.145,95%CI：1.122~4.101）、疾病分期为Ⅲ期（OR=2.863,95%CI：1.576~5.201）均是乳腺癌术后患者负性心理的危险因素（P<0.05）,构建的Nomogram模型预测与实际观测结果的吻合度较好,C-index为0.851（95%CI：0.785~0.855）。结论: 疼痛评分、人均月收入、婚姻状态和疾病分期均为乳腺癌术后患者负性心理的显著影响因素。基于这些因素构建的 Nomogram 模型具有良好的预测价值,可为个性化护理策略的制定提供重要参考依据。
Abstract
Objective To explore the influencing factors of negative psychology in patients with breast cancer after operation, to construct the Nomogram model, and to verify the predictive value of the model. Methods A total of 550 postoperative patients with breast cancer admitted to a tertiary hospital from January 2020 to December 2023 were selected as the research objects. Collect data such as general information, psychological evaluation results, pain score, marital status, per capita monthly income, medical treatment mode, whether radiotherapy and chemotherapy are needed, and disease stages. Logistic regression analysis was used to determine the influencing factors of negative psychology in postoperative patients with breast cancer, and R software was used to construct Nomogram model. Results Pain score (≥ 7 points) (OR=2.438, 95% CI: 1.324-4.490), per capita monthly income (<3000 yuan) (OR=3.334, 95% CI: 1.907-5.830), marital status of unmarried (OR=2.145, 95% CI: 1.122-4.101), and disease stage III (OR=2.863, 95% CI: 1.576-5.201) are all risk factors for negative psychology of patients with breast cancer after surgery. Conclusion Pain score, per capita monthly income, marital status and disease stage are significant influencing factors for negative psychology of breast cancer patients after surgery. The Nomogram model constructed based on these factors has good predictive value and can provide important reference for the formulation of personalized nursing strategies.
关键词
乳腺癌 /
术后 /
负性心理 /
Nomogram /
预测模型
Key words
breast cancer /
postoperative /
negative psychology /
nomogram /
prediction model
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参考文献
[1] BRAY F, LAVERSANNE M, SUNG H, et al.Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries[J]. CA Cancer J Clin.2024, 74(3): 229-263.
[2] SUNG H, FERLAY J, SIEGEL RL, et al. Global Cancer Statistics2020: GLOBOCAN Estimates of Incidence and Mortality Worldwide for 36 Cancers in 185 Countries. CA Cancer J Clin.2021 May; 71(3): 209-249.
[3] 曾明霞. 沃森人文关怀理论的激励式护理改善乳腺癌患者心理弹性的研究[J]. 基层医学论坛, 2025, 292(03): 125-128.
[4] WEIYUN ZHOU, HAO LIU, GUOXIN, et al. The Impact of Psychol3, 4ogical Intervention on Postoperative Nutrition and Psychological State in Patients Undergoing Surgery for Low Rectal Cancer with Stoma Formation[J]. Clinical Nutrition, 2025, 44(2): 345-353.
[5] 朱丽, 苏菲. 影响癌症患者生存质量的心理问题与护理干预探讨[J]. 当代护理, 2023, 4(9): 40-42.
[6] XIE W, LIU M, OKOLI CTC, et al. Construction and evaluation of a predictive model for compassion fatigue among emergency department nurses: A cross-sectional study. Int J Nurs Stud.2023 Dec; 148: 104613.
[7] LIN F, ZHOU M. Development and Validation of a Risk Prediction Model for Depression in Patients with Stroke. Arch Clin Neuropsychol.2025 Mar 7: acaf021.
[8] 严春华, 郑云英, 黄峥嵘. 妊娠期高血压疾病发病的危险因素分析及Nomogram预测模型的构建[J]. 中国妇幼保健, 2025, 40(06): 1073-1076.
[9] 何海英, 王琴, 钟伦淳. 基于社会心理特征因素构建双相情感障碍复发风险Nomogram模型[J]. 全科护理, 2025, 23(03): 565-569.
[10] 鄢子涵, 孟圆圆, 刘晓鹏, 等. 基于R语言的老年COPD患者出院6个月再发AECOPD的Nomogram预测模型构建与验证[J]. 中国老年学杂志, 2024, 44(22): 5438-5443.
[11] HADE EM, YOUNG GS, LOVE RR.Follow-up after sample size re-estimation in a breast cancer randomized trial for disease-free survival[J]. Trials, 2019, 20(1): 1-9.
[12] 叶冬青. 巢式病例对照研究的设计及分析[J]. 疾病控制杂志, 2001, 5(1): 65-68.
[13] 冯新玮, 吴瑛. 癌症患者心理适应问卷中文版的初步修订及信效度检验[J]. 中华现代护理杂志, 2010, 16(5): 497-500.
[14] 官锐园, 李虹, 郭记敏, 等. 简明癌症患者心理适应问卷的初步修订及信效度检验[J]. 中国心理卫生杂志, 2008, 22(08): 617-620.
[15] AMIN MB, GREENE FL, EDGE SB, et al.The eighth edition AJCC cancer staging manual: continuing to build a bridge from a population-based to a more “personalized” approach to cancer staging[J]. CA Cancer J Clin, 2017, 67(2): 93-99.
[16] 刘俐君, 安俊红, 张英, 等. 基于PERMA模式的积极心理干预改善糖尿病足病人心身症状的效果[J]. 护理研究, 2024, 38(04): 714-718.
[17] KIM J, HARPER A, MCCORMACK V, et al.Global patterns and trends in breast cancer incidence and mortality across 185 countries[J]. Nat Med, 2025, (4): 1154-1162.
[18] LI Y, SONG W, , GAO P, et al. Global, regional, and national burden of breast, cervical, uterine, and ovarian cancer and their risk factors among women from 1990 to 2021, and projections to 2050: findings from the global burden of disease study 2021[J]. BMC Cancer, 2025, 25(1): 330.
[19] 田原, 邹振亚, 庞国伟 . 乳腺癌患者化疗期间预期性悲伤与心理弹性的相关性研究[J]. 中国医药导报, 2019, 16(36): 65-68.
[20] BIOKU AA, JIMETA-TUKO JD, HARRIS P, et al.Psychosocial wellbeing of patients with breast cancer following surgical treatment in Northern Nigeria[J]. BMC Psychiatry, 2025, 25(1): 180.
[21] 范丽娜. 叙事护理在乳腺癌化疗期病人中的应用效果[J]. 航空航天医学杂志, 2022, 33(10): 1266-1268.
[22] GETIE A, AYALNEH M, BIMEREW M.Global prevalence and determinant factors of pain, depression, and anxiety among cancer patients: an umbrella review of systematic reviews and meta-analyses[J]. BMC Psychiatry, 2025, 25(1): 156.
[23] PARK JH, CHUN M, BAE SH, et al.Factors influencing psychological distress among breast cancer survivors using machine learning techniques[J], Sci Rep, 2024, 14(1): 15052.
[24] BLOM M, GUICHERIT OR, HOOGWEGT MT.Perfectionism, intolerance of uncertainty and coping in relation to fear of cancer recurrence in breast cancer patients[J]. Psychooncology, 2023, 32(4): 581-588.
[25] WAROQUIER P, DELEVALLEZ F, RAZAVI D, et al.Psychological factors associated with clinical fear of cancer recurrence in breast cancer patients in the early survivorship period[J]. Psychooncology, 2022, 31(11): 1877-1885.
[26] DINKEL A, MARTEN-MITTAG B, KREMSREITER K.Association Between Daily Worry, Pathological Worry, and Fear of Progression in Patients With Cancer[J]. Front Psychol, 2021, 12: 648623.
[27] ZHAO J, YANG DS, LIU YQ, et al.Characteristics of positive and negative effects on the quality of life of breast cancer patients[J]. BMC Psychiatry, 2024, 24(1): 926.
[28] DINAPOLI L, COLLOCA G, DI CAPUA B, et al.Psychological Aspects to Consider in Breast Cancer Diagnosis and Treatment[J]t. Curr Oncol Rep, 2021, 23(3): 38.
[29] 冷梅娜, 齐兴芹, 冷凤娇, 等. 乳腺癌术后患者抑郁、焦虑情绪与生存质量的相关性分析[J]. 心理月刊, 2023, 18(22): 46-48.
[30] ZHENG J, WANG Y, ZHANG C, et al.Correction: Electroacupuncture negatively regulates the Nesfatin-1/ERK/CREB pathway to alleviate HPA axis hyperactivity and anxiety-like behaviors caused by surgical trauma[J]. Chin Med, 2024, 19(1): 133.
[31] NIKLASSON A, FINAN PH, SMITH MT, et al.The relationship between preoperative sleep disturbance and acute postoperative pain control: A systematic review and meta-analysis[J]. Sleep Med Rev, 2025, 79: 102014.
[32] WANG X, XIONG B, WU T, et al.Effect of desflurane maintenance on postoperative sleep quality in patients undergoing elective breast surgery: A non-inferiority randomized controlled trial[J]. Sleep Med, 2024, 121: 287-294.
[33] 陈静, 刘芳, 王艳. 情绪障碍评估联合心理干预对乳腺肿瘤围手术期的效果评价[J]. 现代肿瘤医学, 2023, 31(8): 1567-1571.
[34] ZAHEDI H, ALIZADEH-DIBAZARI Z, MIRGHAFOURVAND M, et al.The effectiveness of couple-based interventions on the marital outcomes of women with genital and breast cancer and their partners: a systematic review and meta-analysis[J]. BMC Cancer, 2024, 24(1): 391.
[35] HAMLISH T, FOSTER ML, STROM S, et al.Impact of a Breast Cancer Diagnosis on Finances and Marital Status in Young Women[J]. BMC Womens Health, 2025, 25(1): 86.
[36] MIN HY, KIM Y, AN HJ.Factors affecting resilience among young breast cancer survivors: A cross-sectional study[J]. Eur J Oncol Nurs, 2025, 75: 102837.
[37] PANGESTU S, RENCZ F.Comprehensive Score for Financial Toxicity and Health-Related Quality of Life in Patients With Cancer and Survivors: A Systematic Review and Meta-Analysis[J]. Value Health, 2023, 26(2): 300-316.
[38] BIAN J, SHEN A, YANG W, et al.Financial toxicity experienced by patients with breast cancer-related lymphedema: a systematic review[J]. Support Care Cancer, 2023, 31(6): 354.
[39] FRANKLIN M, POLLARD D, SAH J, et al.Direct and Indirect Costs of Breast Cancer and Associated Implications: A Systematic Review[J]. Adv Ther, 2024, 41(7): 2700-2722.
[40] OMARI M, AMAADOUR L, ZARROUQ B, et al.Evaluation of psychological distress is essential for patients with locally advanced breast cancer prior to neoadjuvant chemotherapy: baseline findings from cohort study[J]. BMC Women's Health, 2023, 23(1): 445.
[41] 郭璐, 张世玉, 齐燕辉, 等. 中青年乳腺癌患者术后心理反应的变化轨迹及影响因素研究[J]. 护理学杂志, 2024, 39(12): 81-85.
[42] LUQUE SUÁREZ S, OLIVARES CRESPO ME, BRENES SÁNCHEZ JM. Herrera de la Muela M: Immediate Psychological Implications of Risk-Reducing Mastectomies in Women With Increased Risk of Breast Cancer: A Comparative Study[J]. Clin Breast Cancer, 2024, 24(7): 620-629.
基金
沧州市科技计划项目 “CBX4和CBX8在乳腺癌中的表达及其临床意义”（23244102012）
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