病情知晓对胃癌患者血清Cor及IL-2的影响
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[摘要] 目的:研究病情知晓对胃癌患者血清中皮质醇(Cor)、白细胞介素-2(IL-2)水平变化的影响。方法:60例经病理确诊为胃癌的患者,随机分为病情知晓对照组(C组)和病情不知晓组(N组)各30例,病情知晓对照组在入院第2天静脉采血后告知病情,病情不知晓组出院后逐渐告知病情。两组均于入院后第2天和术后第10天,晨6:00静脉采血测Cor和IL-2水平的变化。结果:与术前比较,N组Cor、IL-2两项指标没有改变(P>0.05);C组IL-2明显下降(P<0.01),Cor明显升高(P<0.01)。术后N组血清中Cor水平明显低于C组(P<0.01);IL-2水平明显高于C组(P<0.01)。结论:围术期隐瞒胃癌患者病情可防止过度应激,保持免疫力。
[关键词] 胃癌;病情知晓;皮质醇;白细胞介素-2
[中图分类号] R735.2[文献标识码]A[文章编号]1673-7210(2009)08(c)-039-02
Effect of patient's condition known to the serum levels of Cor, IL-2 of gastric cancer
ZHANG Yongqing, LI Meiling, CUI Jinbei
(Department of Tumor Surgery, Weifang People's Hospital, Weifang 261041,China)
[Abstract] Objective: To study the effect of patient's condition known to the serum levels of Cor, IL-2 of gastric cancer.Methods: 60 cases of gastric cancer diagnosed by pathology were randomly divided into patient's condition known groups(group C) andunknown group(group N), each group with 30 cases. Patients of group C were told patients condition after the second day when the vein blood was collected, while the cases of group N were gradually told the patients condition after leaving hospital. The vein blood of two groups were collected on am 6:00 at the the second day after admission and tenth day after operation, then the serum levels of Cor, IL-2 were detected. Results: Compared with preoperative levels, the postoperative levels of Cor, IL-2 of group N had no statistical difference(P>0.05), but the postoperative levels of IL-2 in group C decreased obviously(P<0.01),the postoperative levels of Cor in group C increased obviously(P<0.01). After operation, the serum levels of Cor of group N were obviously lower than that of group C(P<0.01),but the levels of IL-2 were obviously higher than those of group C. Conclusion: Patient's condition unknown can prevent excessive stress, and keep the immune function.
[Key words] Gastric cancer; Patient's condition known; Cortisol; IL-2
癌症确诊和手术恐惧都是增加应激反应的主要因素,强烈的心理应激对免疫系统有一定的影响,新的条例规定患者有病情知情权。本研究以血清皮质醇(Cor)、白细胞介素-2(IL-2)为评估,探讨病情知晓对胃癌患者免疫系统的影响,报道如下:
1 对象与方法
1.1研究对象
2008年10月~2009年4月,来我院经病理确诊为胃癌患者60例。年龄38～65岁,ASAⅠ～Ⅱ级,无精神病、无特殊用药者。
1.2病情知晓情况
60例胃癌患者按照随机数字表随机分为病情知晓对照组(C组)和病情不知晓组(N组)各30例。
C组在入院第2天静脉采血后,尊重家属的意见,在适当的时机,有陪护的情形下,由主管医师或家属采用委婉的方式告知病情,N组医生、护士及家属严格保密,待手术康复,患者出院后逐渐告知病情。
1.3标本采集
两组均于入院后第2天和术后第10天,晨6:00点空腹采静脉血4 ml,3 000 r/min离心10 min,分离血清,-70℃低温冰箱保存备测Cor和IL-2。
1.4 标本测定
标本收集齐后,由核医学科专业人员,根据说明书采用放免法进行批量测定血清中Cor、IL-2的水平。
1.5 统计学分析
所有数据用均数±标准差(x±s)表示。用SAS 9.02e 统计软件进行统计学分析,先进行方差齐性检验,不同组间同一时间点的比较用单因素方差分析,当差异有显著性,进一步比较采用SNK-q检验。同一组内不同时间点的比较用配对的t检验。P<0.05为有显著性差异。
2 结果
2.1 两组患者一般情况比较
两组患者一般情况比较无明显差别(P>0.05)。
2.2两组手术前后Cor、IL-2检测指标比较
与术前比较,N组Cor、IL-2两项指标没有改变(P>0.05);C组IL-2明显下降(P<0.01),Cor明显升高(P<0.01)。术后N组血清中Cor水平明显低于C组(P<0.01);IL-2水平明显高于C组(P<0.01)。见表1。
表1 手术前后两组间Cor、IL-2比较(ng/ml)
与手术前比较,▲P<0.05,与N组比较,★P<0.01
3 讨论
患者一经确诊,是否以及如何告之病情一直是困扰医生和家属们的难题,一些研究表明肿瘤患者知晓病情后的不同时间内经常会出现不同的精神心理 ......
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