郑琴，王恺，周颖，雷宇峰，黄跃英，冯林美

引用本文： 郑琴，王恺，周颖，雷宇峰，黄跃英，冯林美.自尊和乐观对肝细胞肝癌病人健康相关生活质量与抑郁症影响的中介作用[J].护理研究,2021,35(4):602-607

摘要： [目的]探讨自尊、乐观对肝细胞肝癌（HCC）病人健康相关生活质量（HRQoL）与抑郁症影响的中介作用。[方法]选取我院2017年6月—2019年12月就诊的166例肝细胞肝癌病人，采用欧洲癌症研究和治疗组生活质量问卷-肝细胞肝癌⁃18（EORTC QLQ⁃HCC18）、流调用抑郁自评量表（CES⁃D）、罗森伯格自尊量表（RSES）、生活取向量表（LOT⁃R）进行测评，并进行相关性分析和结构方程模型分析。[结果]EORTC QLQ⁃HCC18、CES⁃D、RSES、LOT⁃R量表评分分别为（30.26±16.85）分、（17.34±2.25）分、（29.59±4.67）分、（29.78±3.14）分；EORTC QLQ⁃HCC18、CES⁃D、RSES、LOT⁃R量表各领域评分均相关（0.05）；HRQoL对抑郁症状影响路径中，RSES调节属于完全中介模型；LOT⁃R调节属于部分中介模型。[结论]自尊对肝细胞肝癌病人HRQoL与抑郁症状的影响中具有完全中介作用，乐观对肝细胞肝癌病人HRQoL与抑郁症状的影响中具有部分中介作用；加强病人自尊、乐观的心理干预有助于减轻病人抑郁症状。

关键词： 肝细胞肝癌;健康相关生活质量;抑郁;自尊;乐观;护理;调查研究

课题： 国家自然科学基金项目(81660490)

ZHENG Qin，WANG Kai，ZHOU Ying，LEI Yufeng，HUANG Yueying，FENG Linmei

Abstract [Objective]To explore the mediating effect of self-esteem and optimism on the health-related quality of life （HRQoL） and depression of patients with hepatocellular carcinoma （HCC）.[Methods]A total of 166 patients with HCC treated in our hospital from June 2017 to December 2019 were selected.The European Organization for Research and Treatment of Cancer （EORTC） Quality of Life Questionnaire⁃Hepatocellular⁃18 （QLQ⁃HCC18），Center for Epidemiological Survey，Depression Scale （CES⁃D），Rosenberg Self⁃Esteem Scale（RSES），and Life Orientation Test （LOT⁃R） were used for evaluation.Then conduct the correlation analysis and structural equation model analysis.[Results]Scores of QLQ⁃HCC18，CES⁃D， RSES，and LOT⁃R were （30.26±16.85），（17.34±2.25），（29.59±4.67），and （29.78±3.14），respectively.EORTC QLQ⁃HCC18，CES⁃D，RSES，and LOT⁃R were correlated with scores in various fields （<0.05）.In the influence path of HRQoL on depressive symptoms，RSES regulation belonged to a complete mediation model and LOT⁃R regulation belonged to partial intermediary model.[Conclusions]Self⁃esteem had a complete mediating effect in the effect of HRQoL on the depressive symptoms of patients with HCC，and optimism had a partial mediating effect in the effect of HRQoL on the depressive symptoms of patients with HCC.Psychological intervention to strengthen the patient's self⁃esteem and optimism could be helpful to reduce the symptoms of depression in patients.

Keywords hepatocellular carcinoma;health-related quality of life;depression;self-esteem;optimism;nursing;investigation study

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