吞咽困难在鼻咽癌调强放疗后幸存者抑郁、焦虑及症状群中的作用：基于横断面研究的潜在剖面与中介分析
The Role of Dysphagia in Depression, Anxiety, and Symptom Clusters Among Nasopharyngeal Carcinoma Survivors After Intensity-Modulated Radiotherapy: A Latent Profile and Mediation Analysis Based on a Cross-Sectional Study.
文献信息
| PMID | 42813324 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Hui Zhao |
| 作者单位 | Sun Yat-sen University Cancer Center, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Guangzhou, P. R. China. |
| 期刊 | Cancer medicine |
| SCI 分区 | Q2 |
| IF | 3.6 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 鼻咽癌 |
中文摘要
目的： 识别鼻咽癌（NPC）幸存者中不同的吞咽困难剖面，并检验抑郁和焦虑在这些剖面与更广泛症状群关系中的中介作用。本研究假设亚组归属会通过心理中介路径对症状群产生差异化影响。本研究旨在为制定精准症状管理干预措施提供证据。
方法： 在这项横断面研究中，271名从广州一家三级肿瘤医院招募的幸存者（2023年1月至2024年12月）完成了吞咽困难、心理状态和症状的标准化评估。潜在剖面分析（LPA）识别了具有不同吞咽困难剖面的幸存者亚组；探索性因子分析提取症状群，多变量线性回归检验相关因素，采用 bootstrap 重抽样的平行中介分析检验中介效应。
结果： NPC幸存者中吞咽困难患病率为57.2%，其中治疗后6个月内的幸存者患病率最高（72.7%）。LPA识别出两个具有不同吞咽困难剖面的幸存者亚组：高吞咽困难负担亚组（51.0%）和低吞咽困难负担亚组（49.0%）。提取出三个症状群：全身/心理、口腔/吞咽和胃肠道/神经病理性。高吞咽困难负担亚组归属和焦虑显著预测所有症状群（p < 0.05）。中介分析显示，吞咽困难亚组归属对所有症状群均有显著总效应（p < 0.001）。抑郁对全身/心理和口腔/吞咽症状群显示出统计学中介作用，而焦虑对全身/心理和胃肠道/神经病理性症状群显示出统计学中介作用。
结论： NPC幸存者表现出不同的吞咽困难负担剖面，包括高负担和低负担亚组。高吞咽困难负担剖面与更大的总体症状负担直接相关，并通过抑郁和焦虑间接导致更严重的症状群。这些发现强调需要早期识别该高风险亚组中的幸存者，并将吞咽康复与心理干预相结合以实现全面的症状管理。
英文摘要
OBJECTIVE: To identify distinct dysphagia profiles among nasopharyngeal carcinoma (NPC) survivors and to examine the mediating roles of depression and anxiety in the relationship between these profiles and broader symptom clusters. This study hypothesized that subgroup membership would have differential effects on symptom clusters through psychological mediating pathways. The study aimed to provide evidence for the development of precision symptom management interventions.
METHODS: In this cross-sectional study, 271 survivors recruited from a tertiary cancer hospital in Guangzhou (January 2023-December 2024) completed standardized assessments of dysphagia, psychological status, and symptoms. Latent profile analysis (LPA) identified subgroups of survivors with distinct dysphagia profiles; exploratory factor analysis extracted symptom clusters, multivariable linear regression examined associated factors, and parallel mediation analysis with bootstrap resampling tested the mediating effects.
RESULTS: Dysphagia prevalence among NPC survivors was 57.2%, with the highest prevalence (72.7%) observed among survivors within 6 months post-treatment. LPA identified two survivor subgroups with distinct dysphagia profiles: a high dysphagia burden subgroup (51.0%) and a low dysphagia burden subgroup (49.0%). Three symptom clusters were extracted: Systemic/Psychological, Oral/Swallowing, and Gastrointestinal/Neuropathic. Membership in the high dysphagia burden subgroup and anxiety significantly predicted all clusters (p < 0.05). Mediation analyses revealed that dysphagia subgroup membership had significant total effects on all clusters (p < 0.001). Depression showed statistical mediation for the Systemic/Psychological and Oral/Swallowing clusters, whereas anxiety showed statistical mediation for the Systemic/Psychological and Gastrointestinal/Neuropathic clusters.
CONCLUSIONS: NPC survivors exhibit distinct dysphagia burden profiles, including high- and low-burden subgroups. A high dysphagia burden profile is directly associated with a greater overall symptom burden and indirectly contributes to more severe symptom clusters via depression and anxiety. These findings highlight the need for early identification of survivors within this high-risk subgroup, and the integration of swallowing rehabilitation with psychological interventions for comprehensive symptom management.