老年多发性骨髓瘤化疗患者症状群特征及其相关因素分析

Analysis of characteristics and related factors of symptom clusters in elderly patients with multiple myeloma undergoing chem-otherapy

中文关键词: 老年  多发性骨髓瘤  症状群调查  Logistics回归分析

英文关键词: elderly  multiple myeloma  symptom cluster investigation  logistic regression analysis

中文摘要:

      目的 分析老年多发性骨髓瘤(multiple myeloma,MM)化疗患者症状群特征及其相关因素.方法 回顾性分析2020 年9 月—2022 年9 月于四川大学华西医院血液内科收治的老年MM患者的临床资料,调查180 例老年MM患者一般人口学资料分布情况、疾病相关资料、症状群分布现状、体能状态[美国东部肿瘤协作组体能状态(ECOG)评分]及社会支持情况[社会支持评定量表(SSRS)],分析影响老年MM化疗患者各症状群严重程度的单因素,进行多因素Logistic回归分析,分析影响老年MM化疗患者各症状群严重程度的独立危险因素.结果 180 例老年MM化疗患者出现 18 种主要症状的发生率在35.61%～75.10%,其中症状发生率最高为口干(75.10%),其次精力不足(70.21%),再次之为疼痛(69.52%);症状发生频次首位为手脚麻痹或刺痛(55.12%),其次疼痛(45.15%),最次难以入睡(37.15%);担忧症状最严重,其次手脚麻痹,再次为精力不足;受难以睡症状(31.30%)困扰程度最严重,其次是口干(30.60%),再次之为手脚麻痹或刺痛(27.80%).疾病知晓程度为影响骨痛心理、消化道以及疲乏共3 个症状群严重程度的单因素(P＜0.05),化疗方案为影响药物相关症状群严重程度的单因素(P＜0.05),化疗周期为影响骨痛心理、神经系统共2 个症状群严重程度的单因素(P＜0.05),涉及疲乏和骨髓抑制共2 个症状群严重程度的单因素则为复发(P＜0.05),涉及骨痛心理、疲乏、消化道、神经系统共4 个症状群严重程度的单因素则是体能状态(P＜0.05),涉及造成药物相关症状群及骨痛心理症状严重程度的单因素则为社会支持(P＜0.05);病情知晓程度、化疗方案、化疗周期、社会支持、体能状态是影响老年MM化疗患者各症状群严重程度的独立危险因素(P＜0.05).结论 老年MM化疗患者极易发生骨痛心理症状群、消化道症状群、疲乏症状群、药物相关症状群、骨髓抑制症状群、神经系统症状群,而病情知晓程度、化疗周期、社会支持、体能状态是影响各症状群严重程度的独立危险因素,临床需针对相关因素进行早期干预,以减轻或预防各症状群发生.

英文摘要:

      Objective To analyze the characteristics and related factors of symptom clusters in elderly patients with multiple myeloma(MM)undergoing chemotherapy.Methods The clinical data of elderly MM patients admitted to Depart-ment of Hematology,West China Hospital of Sichuan University from September 2020 to September 2022 were retrospectively analyzed.The general demographic data distribution,disease-related data,symptom cluster distribution,physical performance status[Eastern Cooperative Oncology Group(ECOG)]and social support[Social Support Rating Scale(SSRS)]of 180 eld-erly MM patients were investigated.The single factors affecting the severity of each symptom cluster in elderly patients with MM chemotherapy were analyzed.Multivariate logistic regression analysis was performed to analyze the independent risk fac-tors affecting the severity of each symptom cluster in elderly patients with MM chemotherapy.Results The incidences of 18 main symptoms in180 elderly patients with MM chemotherapy ranged from 35.61%to 75.10%.The highest incidence of symptoms was dry mouth(75.10%),followed by anenergia(70.21%),and pain(69.52%).The symptom with top occur-rence frequency was hand-foot paralysis or tingling(55.12%),followed by pain(45.15%)and difficulty in falling asleep(37.15%).Worry was the most serious symptom,followed by hand-foot paralysis,and anenergia.The symptom with most serious distressdegree wasdifficulty in falling asleep(31.30%),followed by dry mouth(30.60%)and hand-foot paralysisor tingling(27.80%).The disease awareness degree was a single factor affecting the severity of three symptom clusters of bone pain psychology,digestive tract and fatigue(P＜0.05).Chemotherapy regimen was a single factor affecting the severity of drug-related symptom cluster(P＜0.05).Chemotherapy cycle was a single factor affecting the severity of two symptom clus-ters of bone pain psychology and nervous system(P＜0.05).The single factor involving the severity of two symptom clusters of fatigue and myelosuppression was recurrence(P＜0.05).The single factor involving the severity of four symptom clusters of bone pain psychology,fatigue,digestive tract and nervous system was physical performance status(P＜0.05).The single factor involving the severity of drug-related symptom cluster and bone pain psychological symptom was social support(P＜0.05).The disease awareness degree,chemotherapy regimen,chemotherapy cycle,social support and physical performance status were independent risk factors affecting the severity of each symptom cluster in elderly patients with MM chemotherapy(P＜0.05).Conclusion Elderly patients with MM chemotherapy are prone to psychological symptom cluster of bone pain,digestive tract symptom cluster,fatigue symptom cluster,drug-related symptom cluster,myelosuppression symptom cluster and nervous system symptom cluster.The disease awareness,chemotherapy cycle,social support and physical performance status are independent risk factors affecting the severity of each symptom cluster.Clinical early intervention should be carried out ac-cording to these related factors to reduce or prevent the occurrence of each symptom clusters.