SELDI技术检测癌症患者血清中焦虑相关蛋白质组指纹的临床研究
|
摘要
目的:应用飞行质谱技术(SELDI-TOF-MS)筛选一组住院癌症患者血清中焦虑相关蛋白质组的指纹图谱,并建立诊断模型,与汉密尔顿焦虑评定量表(HAMA)对癌症患者焦虑状况的评估结果作比较研究,初步探讨其科学性及临床应用价值。
方法:125例住院癌症患者入选为研究对象,首先对患者进行汉密尔顿焦虑量表的评估,以总分≥14分为焦虑判断标准,依此分为焦虑组和非焦虑组,然后于评估次日抽取患者空腹静脉血,应用飞行质谱技术和CM10蛋白质芯片进行蛋白质指纹图谱检测,分别观察两组中的差异蛋白质指纹,筛选与焦虑相关的蛋白质组指纹图谱,与量表评分的结果进行比较分析。以质荷比15000Da-16800Da之间5%蛋白质指纹丰度值为诊断界值,以汉密尔顿焦虑量表评估为金标准,评价该方法的正确率(总符合率)、灵敏度、特异度、阳性预测值和阴性预测值。
结果:①125例癌症患者经汉密尔顿焦虑量表评估,量表评分均值为14.66±8.24,以总分≥14分为焦虑判断标准,有49人为焦虑患者,其余76例为非焦虑患者,阳性发生率为39.20%。②在患者的血清蛋白质图谱检测中,在质荷比15000Da-16800Da之间,焦虑患者与非焦虑患者SELDI蛋白质组指纹丰度有明显差异性表达图谱(t=4.378,p<0.05),且与量表评分有相关性,呈正相关(P=0.001,r=0.809),质荷比(M/Z)为15000Da—16800Da处的单组或双组峰簇可能为焦虑症相关蛋白质指纹。③以质荷比15000Da-16800Da之间5%蛋白质指纹丰度建立诊断模型可以将癌症焦虑患者准确区分。该方法的正确率(总符合率)为93.27%(111/119),灵敏度和特异度分别为93.61%(44/47)、93.05%(67/72)。阳性预测值为89.79%(44/49),阴性预测值为95.71%(67/70)。
结论:运用飞行质谱技术(SELDI-TOF-MS)可快速、准确地检测癌症患者焦虑情绪的存在,质荷比15000Da-16800Da之间5%蛋白质指纹丰度为癌症患者焦虑相关蛋白质指纹。以汉密尔顿焦虑量表评估为金标准,该方法的灵敏度为93.61%,特异度为93.05%,阳性预测值为89.79%,阴性预测值为95.71%,具有良好的临床应用前景。
Object: Using SELDI-TOF-MS technology to screen the serum protein fingerprint related to anxiety in a group of cancer patients and develop diagnostic patterns.Compared with the results of Hamilton Anxiety Scale in cancer patients.then evaluate its clinical significance.
Methods: 125 cases cancer patients were collected in this experiment.They were investigated by the Hamilton Anxiety Scale first,all the patients were divided into two groups(anxiety group and non-anxiety group) by the standard of≥14 scores, then the SELDI-TOF-MS technology and the CM10 protein chip were used to screen the serum protein fingerprint related to anxiety.Using the 5% protein fingerprint peak as the diagnosis model and HAMA as the gold standard to evaluate the correct ratio,sensitivity, specificity, positive predict value and negative predict value of this method.
Results:①125 cases cancer patients were investigated by the Hamilton Anxiety Scale,49 cases of the cancer patients were judged as anxious patients and the other 76 cases were the non- anxious patients by the standard of≥14 scores,the occurrence rate is 39.20%;②In patient's serum protein examination, at the M/Z values range from 15000Da to16800Da,there were obviously different protein fingerprint between the serum of anxious patients and the serum of non-anxious patient.There was a positive correlation between the results of the serum protein fingerprint and the Hamilton anxiety scale(P=0.001,r=0.809). This serum protein fingerprint can be regarded as a specific serum biomarker to anxious cancer patients;③The diagnosis model of 5% protein fingerprint peak could be utilized to analyze protein profiling in screening anxious-related cancer patient.The correct ratio(total coincidence rate) is 93.27%,(111/119),the sensitivity and the specificity respectively are 93.61%(44/47), 93.05% (67/72).The positive predict value is 89.79%﹝44/49﹞,the negative predict value is 95.71%﹝67/70﹞.
Conclusion: SELDI-TOF-MS technology can be used quickly and exactly in the detection of the serum protein fingerprint related to anxiety in cancer patiets. At the M/Z values range from 15000Da to16800Da,5% protein fingerprint peak can be regard as Anxiety Protein Fingerprint. with high sensitivity and specificityTthis method will be widely used in clinical application.
方法:125例住院癌症患者入选为研究对象,首先对患者进行汉密尔顿焦虑量表的评估,以总分≥14分为焦虑判断标准,依此分为焦虑组和非焦虑组,然后于评估次日抽取患者空腹静脉血,应用飞行质谱技术和CM10蛋白质芯片进行蛋白质指纹图谱检测,分别观察两组中的差异蛋白质指纹,筛选与焦虑相关的蛋白质组指纹图谱,与量表评分的结果进行比较分析。以质荷比15000Da-16800Da之间5%蛋白质指纹丰度值为诊断界值,以汉密尔顿焦虑量表评估为金标准,评价该方法的正确率(总符合率)、灵敏度、特异度、阳性预测值和阴性预测值。
结果:①125例癌症患者经汉密尔顿焦虑量表评估,量表评分均值为14.66±8.24,以总分≥14分为焦虑判断标准,有49人为焦虑患者,其余76例为非焦虑患者,阳性发生率为39.20%。②在患者的血清蛋白质图谱检测中,在质荷比15000Da-16800Da之间,焦虑患者与非焦虑患者SELDI蛋白质组指纹丰度有明显差异性表达图谱(t=4.378,p<0.05),且与量表评分有相关性,呈正相关(P=0.001,r=0.809),质荷比(M/Z)为15000Da—16800Da处的单组或双组峰簇可能为焦虑症相关蛋白质指纹。③以质荷比15000Da-16800Da之间5%蛋白质指纹丰度建立诊断模型可以将癌症焦虑患者准确区分。该方法的正确率(总符合率)为93.27%(111/119),灵敏度和特异度分别为93.61%(44/47)、93.05%(67/72)。阳性预测值为89.79%(44/49),阴性预测值为95.71%(67/70)。
结论:运用飞行质谱技术(SELDI-TOF-MS)可快速、准确地检测癌症患者焦虑情绪的存在,质荷比15000Da-16800Da之间5%蛋白质指纹丰度为癌症患者焦虑相关蛋白质指纹。以汉密尔顿焦虑量表评估为金标准,该方法的灵敏度为93.61%,特异度为93.05%,阳性预测值为89.79%,阴性预测值为95.71%,具有良好的临床应用前景。
Object: Using SELDI-TOF-MS technology to screen the serum protein fingerprint related to anxiety in a group of cancer patients and develop diagnostic patterns.Compared with the results of Hamilton Anxiety Scale in cancer patients.then evaluate its clinical significance.
Methods: 125 cases cancer patients were collected in this experiment.They were investigated by the Hamilton Anxiety Scale first,all the patients were divided into two groups(anxiety group and non-anxiety group) by the standard of≥14 scores, then the SELDI-TOF-MS technology and the CM10 protein chip were used to screen the serum protein fingerprint related to anxiety.Using the 5% protein fingerprint peak as the diagnosis model and HAMA as the gold standard to evaluate the correct ratio,sensitivity, specificity, positive predict value and negative predict value of this method.
Results:①125 cases cancer patients were investigated by the Hamilton Anxiety Scale,49 cases of the cancer patients were judged as anxious patients and the other 76 cases were the non- anxious patients by the standard of≥14 scores,the occurrence rate is 39.20%;②In patient's serum protein examination, at the M/Z values range from 15000Da to16800Da,there were obviously different protein fingerprint between the serum of anxious patients and the serum of non-anxious patient.There was a positive correlation between the results of the serum protein fingerprint and the Hamilton anxiety scale(P=0.001,r=0.809). This serum protein fingerprint can be regarded as a specific serum biomarker to anxious cancer patients;③The diagnosis model of 5% protein fingerprint peak could be utilized to analyze protein profiling in screening anxious-related cancer patient.The correct ratio(total coincidence rate) is 93.27%,(111/119),the sensitivity and the specificity respectively are 93.61%(44/47), 93.05% (67/72).The positive predict value is 89.79%﹝44/49﹞,the negative predict value is 95.71%﹝67/70﹞.
Conclusion: SELDI-TOF-MS technology can be used quickly and exactly in the detection of the serum protein fingerprint related to anxiety in cancer patiets. At the M/Z values range from 15000Da to16800Da,5% protein fingerprint peak can be regard as Anxiety Protein Fingerprint. with high sensitivity and specificityTthis method will be widely used in clinical application.
引文
[1]黄丽,罗健.肿瘤心理治疗[M].北京:人民卫生出版社, 2000, 444-445
[2] Vera A,Parikh P,Shanthi N,et al.Role of hospital anxiety depression scale in reducing need of a formal psychiatric referral in cancer patients [J].journal of clinical oncology,2005 ASCO Annual Meeting Proceedings,2005,16﹙1﹚:25
[3] Zaborn J Brintzenhofe Szoc K,Curbow B,et al The prevalence of psychological distress by cancer site[J].Psycho-oncology,2002,22﹙7﹚:19-28
[4]安丰妹,刁惠民,康丽燕,等.社会心理因素对断指再植术后患者手指功能恢复的影响[J].中华护理杂志,2002,11(12):61-62
[5] Sammarco,A.Psychosocial stages and quality of life of Women with breast cancer[J].Cancer Nurs,2001,24﹙4﹚:272-277
[6] Stuart-Shor,E.M.,Buselli,E F,et al.Are psychosocial factors associated with the pathogenesis and consequences of cardiovascular disease in the elderly?.[J] Cardiovasc Nurs,2003,18﹙3﹚:169-183
[7]万丽红,刘明,潘承恩.癌症患者发生抑郁的相关因素[J].中华护理杂志,2002,37﹙5﹚:373-374
[8]肖雪媛,卫秀平,何大澄.应用蛋白质芯片技术从血清中筛选肺癌标志蛋白[J].中国科学,2003,33﹙4﹚:323-328.
[9] Herbert BR,Harry JL,Packer NH,et al.What place for polyacrylamide in proteomics[J] Trends Biotechnol,2001,19﹙10﹚:3-9
[10]汪向东,王希林,马弘等.心理卫生评定量表手册(增订版)[M].中国心理卫生杂志社,1999,253-256.
[11]叶琴琴,杨亚娟.癌症患者抑郁状态的研究现状[J].国外医学护理学分册,2003,22﹙8﹚:362-363
[12] Korostil,M.and Feinstein, A.Anxiety disorders and their clinical correlates in multiple sclerosis patients[J],Mult Scler,2007,13﹙1﹚:67-72
[13]韩继明护理心理学[M]北京:清华大学出版社,2006,175-179
[14]戚厚兴,等.冠心病患者焦虑情绪与血清氧化低密度脂蛋白含量的关系[J].中国行为医学科学,2006,15﹙4﹚:313-315
[15]方建群,白秀琴冠心病患者的抑郁症状与C-反应蛋白的相关性研究[J].宁夏医学院学报, 2006,28﹙6﹚:78-79
[16] Davies H ,Lomas L ,Austen B, Profiling of amyloid betapeptide variants using SELDI Protein Chip arrays[J]. Biotechniques, 1999 ,27﹙6﹚:1258
[17] Kromer SA, Kessler MS.Identification of glyoxalase-I as a protein marker in a mouse model of extremes in trait anxiety.[J] Neurosci, 2005,25﹙17﹚:437-438
[18] Uys JD, Stein DJ, Daniels WM .Neuroproteomics: relevance to anxiety disorders.[J].Curr Psychiatry Rep,2006,8﹙4﹚:86-90.
[19] Li H, Zhang X, Guo Y, et al. A case-control study of genetic association of the PLA2G4A gene with schizophrenia in a Chinese population[J]. Psychiatr Genet,2007,17﹙3﹚:205.
[20] Steiner J,Bielau H, Bemstein HG, et al. Increased cerebrospinal fluid and serum levels of S100B in first-on set schizophrenia are not related to a degenerative release of glial fibrillar acidic protein,myelin basic protein and neurone-specific enolase from glia or neurones[J]. J Neurol Neurosurg Psychiatry, 2006,77﹙11﹚:1284 -1287.
[21]姜伟,王开正,白克镇,等.精神分裂症患者血清蛋白标志物的临床应用研究[J].中国神经精神疾病杂志, 2008,34﹙1﹚:27-30
[22] Conrads TP,Fusaro VA,Ross S,et al.Proteomic patterns as a diagnostic tool for early- stage cancer:A review of its progress to a clinically relevant tool[J].Mol Dia,2004,8﹙2﹚:77-85
[23] Pandey A,Mann M.Proteomics to study genes andgenomes .Nature2000,405(6788):837-46.
[24] Anderson NL,Anderson NG.The human plasma proteome:history,characterand diagnostic Prospects[J].Mol Cell Proteomics,2002,l﹙11﹚:845-867
[25] Liotta LA,Ferrari M,Petricoin E.clinical protiomics:Written in blood[J].Nature,2003,425﹙6961﹚:905
[26] Petrcoin EF, Ardekani AM, Hitt BA,et al.Use of proteomic Patterns in serum to identify ovarian cancer[J] .Lancet, 2002,359﹙9306﹚:572-577
[27] Poon TCW,Yip TT,Yasui Y,et al.Comprehensive proteomic profiling identifies serum proteomic signatureres for detection of hepatocellular carcinoma and its subtypes[J].Clin Chem, 2003,49﹙5﹚:752-760
[28] Benz.LL,Prasanna P,Sun L,Adam BL,Mcleod DG,Srivastava S.Diagnostic potential of serum proteomic patterns in prostate cancer.[J].J Urol, 2003,170﹙5﹚:1782-1787
[29]刘振静,吴爱勤,陈文.癌症患者焦虑状态的相关因素[J].中国心理卫生杂志,2006:20﹙9﹚ 607-608.
[30] Sarah ford et al.Psychological morbidity in newly referred patients with cancer[J] Psychosomatic Research,1995,39﹙2﹚:193-195
[31]闵军霞.癌症患者心理反应调查分析及相关性研究[J].中华护理杂志,1999 ,34﹙3﹚:180-182
[32]王清馨,姚壁.一组与焦虑症相关的蛋白质组指纹的研究报告[J].肿瘤研究与临床, 2008,10﹙5﹚:435-439
[1]叶琴琴,杨亚娟.癌症患者抑郁状态的研究现状[J].国外医学护理学分册,2003,22﹙8﹚:362-363
[2] Zabora J Brintzenhofe Szoc K,Curbow B,et al. The prevalence of psychological distress by cancer site[J].Psycho-oncology,2002,19-28
[3]胡永年,刘小虹护理心理学[M].北京:中国中医药出版社,2005,93-95
[4]陈素坤.临床心理护理指导[M].北京:科学技术文献出版社,2002,165-166
[5]汪向东.心理卫生评定量表手册[M].中国心理卫生杂志社,1993,31-35
[6] Bjelland I,Dahl AA,Tangen Haug T,et al.The Validity of the Hospital Anxiety and Depression Scale:An updated literature review.[J] Psychosom Res,2002,52﹙9﹚:69-77
[7] Zigmond AS,Snaith RP The Hospital Anxiety And Depression Scale[J].Acta Psychiatr Scand,1983,67﹙3﹚:68-70
[8]郑林科,张天龄.临床心理护理量表的编制与初步应用[J〕.中国行为医学,2000,9﹙2﹚:90-93
[9]王逸如,黄华兰,王妙君肺癌患者心理健康状况的相关性研究[J]国际护理学杂志,2007,26﹙3﹚:236-237
[10]孙明子,金香玉.肺部恶性肿瘤患者的心理状况分析[J].中国社区医师, 2007,9﹙16﹚:81
[11]郑冬燕,于莹,王丽芹.妇科恶性肿瘤患者心理状态及影响因素分析与对策[J]现代护理,2006,12﹙1﹚:56-57
[12]李冬梅,王梅.乳腺癌患者临床心理干预效果评估[J]中国康复理论与实践, 2006 12﹙4﹚: 953-955
[13] Mogens G, Peter M F,Mirjam A G, et al. Anxiety and depression in breast cancer patients at low risk of recurrence compared with the general population: A valid comparison? [J]. J Clin Epidemiol,1999,52﹙6﹚:523-530.
[14] HallA R, Fallowfield A L. Are we using appropriate self report questionnaires for detecting anxiety and depression in women with early breast cancer?[J]. Euro J Cancer,1999,35﹙1﹚:79 85.
[15]何晓华,吴光峰,金晓威胃癌住院患者心理状况相关因素的调查分析[J]现代肿瘤医学, 2007,15﹙7﹚: 3401-3405
[16]胡雁Ken Sellick消化道恶性肿瘤患者焦虑和抑郁及生命质量追踪调查[J]中国心理卫生杂志,2003,l7(l2):810-812
[17]王兰英.骨肿瘤患者情绪障碍护理探讨[J].医学论坛杂志,2004,25﹙14﹚:24-25.
[18]徐恩斌,蔡永国,白厚喜消化系恶性肿瘤患者的心理状况及生活质量调查[J]中华现代内科学杂志, 2007 ,4﹙3﹚:216-217
[19]杜树发,施吕元,张惠元,等.前列腺癌患者的生命质量研究[J].中华流行病学杂志,1997,18﹙2﹚:95-97.
[20]齐艳,刘晓虹,沈丽,等.肝癌患者心理状态与个性的评估及分析[J].中华护理杂志, 2004,39﹙2﹚: 153-154
[21] Charles M,Marilyn P, Kirsten T, et al. Predicting psychological distress in patients with leukaemia and lymphoma[J].Psycho Res, 2003,54﹙4﹚:289-292.
[22]韩继明护理心理学[M]北京:清华大学出版社,2006,179
[23]郑瑾,孙田杰,沙儒,等. 317例癌症患者身心需要的调查[J].中华护理杂志,2004,39﹙8﹚:585-587.
[24]闰来荣,魏红艳,张龚,等.癌症患者家庭成员的心理健康状况调查及相关因素分析[J].中国行为医学,2004,13﹙5﹚:514-515.
[25]孙振球徐勇勇医学统计学[M].北京:人民卫生出版社,2006,535
[26]王国强.心身疾病的心理护理原则和目标[J].实用护理杂志,2000,16﹙4﹚:42
[27] Genevieve W R. releases statement on managing pain, depression and fatigue in cancer [J]. Am Fami Physi,2003,67﹙2﹚:423-425.
[28]安丰妹,刁惠民,康丽燕,等.社会心理因素对断指再植术后患者手指功能恢复的影响[J].中华护理杂志,2002,32﹙12﹚:61-62
[29]陈国清,孙青,于洪芳,等.导入心理护理量表与整体护理满意度的相关性研究[J].齐鲁护理杂志,2001,7﹙5﹚:382
[30]郭晓霞,黄唯麟,宋代良,等.血液透析患者性格特征的相关分析及护理对策[J].现代护理,2004,10﹙4﹚:344-346
[2] Vera A,Parikh P,Shanthi N,et al.Role of hospital anxiety depression scale in reducing need of a formal psychiatric referral in cancer patients [J].journal of clinical oncology,2005 ASCO Annual Meeting Proceedings,2005,16﹙1﹚:25
[3] Zaborn J Brintzenhofe Szoc K,Curbow B,et al The prevalence of psychological distress by cancer site[J].Psycho-oncology,2002,22﹙7﹚:19-28
[4]安丰妹,刁惠民,康丽燕,等.社会心理因素对断指再植术后患者手指功能恢复的影响[J].中华护理杂志,2002,11(12):61-62
[5] Sammarco,A.Psychosocial stages and quality of life of Women with breast cancer[J].Cancer Nurs,2001,24﹙4﹚:272-277
[6] Stuart-Shor,E.M.,Buselli,E F,et al.Are psychosocial factors associated with the pathogenesis and consequences of cardiovascular disease in the elderly?.[J] Cardiovasc Nurs,2003,18﹙3﹚:169-183
[7]万丽红,刘明,潘承恩.癌症患者发生抑郁的相关因素[J].中华护理杂志,2002,37﹙5﹚:373-374
[8]肖雪媛,卫秀平,何大澄.应用蛋白质芯片技术从血清中筛选肺癌标志蛋白[J].中国科学,2003,33﹙4﹚:323-328.
[9] Herbert BR,Harry JL,Packer NH,et al.What place for polyacrylamide in proteomics[J] Trends Biotechnol,2001,19﹙10﹚:3-9
[10]汪向东,王希林,马弘等.心理卫生评定量表手册(增订版)[M].中国心理卫生杂志社,1999,253-256.
[11]叶琴琴,杨亚娟.癌症患者抑郁状态的研究现状[J].国外医学护理学分册,2003,22﹙8﹚:362-363
[12] Korostil,M.and Feinstein, A.Anxiety disorders and their clinical correlates in multiple sclerosis patients[J],Mult Scler,2007,13﹙1﹚:67-72
[13]韩继明护理心理学[M]北京:清华大学出版社,2006,175-179
[14]戚厚兴,等.冠心病患者焦虑情绪与血清氧化低密度脂蛋白含量的关系[J].中国行为医学科学,2006,15﹙4﹚:313-315
[15]方建群,白秀琴冠心病患者的抑郁症状与C-反应蛋白的相关性研究[J].宁夏医学院学报, 2006,28﹙6﹚:78-79
[16] Davies H ,Lomas L ,Austen B, Profiling of amyloid betapeptide variants using SELDI Protein Chip arrays[J]. Biotechniques, 1999 ,27﹙6﹚:1258
[17] Kromer SA, Kessler MS.Identification of glyoxalase-I as a protein marker in a mouse model of extremes in trait anxiety.[J] Neurosci, 2005,25﹙17﹚:437-438
[18] Uys JD, Stein DJ, Daniels WM .Neuroproteomics: relevance to anxiety disorders.[J].Curr Psychiatry Rep,2006,8﹙4﹚:86-90.
[19] Li H, Zhang X, Guo Y, et al. A case-control study of genetic association of the PLA2G4A gene with schizophrenia in a Chinese population[J]. Psychiatr Genet,2007,17﹙3﹚:205.
[20] Steiner J,Bielau H, Bemstein HG, et al. Increased cerebrospinal fluid and serum levels of S100B in first-on set schizophrenia are not related to a degenerative release of glial fibrillar acidic protein,myelin basic protein and neurone-specific enolase from glia or neurones[J]. J Neurol Neurosurg Psychiatry, 2006,77﹙11﹚:1284 -1287.
[21]姜伟,王开正,白克镇,等.精神分裂症患者血清蛋白标志物的临床应用研究[J].中国神经精神疾病杂志, 2008,34﹙1﹚:27-30
[22] Conrads TP,Fusaro VA,Ross S,et al.Proteomic patterns as a diagnostic tool for early- stage cancer:A review of its progress to a clinically relevant tool[J].Mol Dia,2004,8﹙2﹚:77-85
[23] Pandey A,Mann M.Proteomics to study genes andgenomes .Nature2000,405(6788):837-46.
[24] Anderson NL,Anderson NG.The human plasma proteome:history,characterand diagnostic Prospects[J].Mol Cell Proteomics,2002,l﹙11﹚:845-867
[25] Liotta LA,Ferrari M,Petricoin E.clinical protiomics:Written in blood[J].Nature,2003,425﹙6961﹚:905
[26] Petrcoin EF, Ardekani AM, Hitt BA,et al.Use of proteomic Patterns in serum to identify ovarian cancer[J] .Lancet, 2002,359﹙9306﹚:572-577
[27] Poon TCW,Yip TT,Yasui Y,et al.Comprehensive proteomic profiling identifies serum proteomic signatureres for detection of hepatocellular carcinoma and its subtypes[J].Clin Chem, 2003,49﹙5﹚:752-760
[28] Benz.LL,Prasanna P,Sun L,Adam BL,Mcleod DG,Srivastava S.Diagnostic potential of serum proteomic patterns in prostate cancer.[J].J Urol, 2003,170﹙5﹚:1782-1787
[29]刘振静,吴爱勤,陈文.癌症患者焦虑状态的相关因素[J].中国心理卫生杂志,2006:20﹙9﹚ 607-608.
[30] Sarah ford et al.Psychological morbidity in newly referred patients with cancer[J] Psychosomatic Research,1995,39﹙2﹚:193-195
[31]闵军霞.癌症患者心理反应调查分析及相关性研究[J].中华护理杂志,1999 ,34﹙3﹚:180-182
[32]王清馨,姚壁.一组与焦虑症相关的蛋白质组指纹的研究报告[J].肿瘤研究与临床, 2008,10﹙5﹚:435-439
[1]叶琴琴,杨亚娟.癌症患者抑郁状态的研究现状[J].国外医学护理学分册,2003,22﹙8﹚:362-363
[2] Zabora J Brintzenhofe Szoc K,Curbow B,et al. The prevalence of psychological distress by cancer site[J].Psycho-oncology,2002,19-28
[3]胡永年,刘小虹护理心理学[M].北京:中国中医药出版社,2005,93-95
[4]陈素坤.临床心理护理指导[M].北京:科学技术文献出版社,2002,165-166
[5]汪向东.心理卫生评定量表手册[M].中国心理卫生杂志社,1993,31-35
[6] Bjelland I,Dahl AA,Tangen Haug T,et al.The Validity of the Hospital Anxiety and Depression Scale:An updated literature review.[J] Psychosom Res,2002,52﹙9﹚:69-77
[7] Zigmond AS,Snaith RP The Hospital Anxiety And Depression Scale[J].Acta Psychiatr Scand,1983,67﹙3﹚:68-70
[8]郑林科,张天龄.临床心理护理量表的编制与初步应用[J〕.中国行为医学,2000,9﹙2﹚:90-93
[9]王逸如,黄华兰,王妙君肺癌患者心理健康状况的相关性研究[J]国际护理学杂志,2007,26﹙3﹚:236-237
[10]孙明子,金香玉.肺部恶性肿瘤患者的心理状况分析[J].中国社区医师, 2007,9﹙16﹚:81
[11]郑冬燕,于莹,王丽芹.妇科恶性肿瘤患者心理状态及影响因素分析与对策[J]现代护理,2006,12﹙1﹚:56-57
[12]李冬梅,王梅.乳腺癌患者临床心理干预效果评估[J]中国康复理论与实践, 2006 12﹙4﹚: 953-955
[13] Mogens G, Peter M F,Mirjam A G, et al. Anxiety and depression in breast cancer patients at low risk of recurrence compared with the general population: A valid comparison? [J]. J Clin Epidemiol,1999,52﹙6﹚:523-530.
[14] HallA R, Fallowfield A L. Are we using appropriate self report questionnaires for detecting anxiety and depression in women with early breast cancer?[J]. Euro J Cancer,1999,35﹙1﹚:79 85.
[15]何晓华,吴光峰,金晓威胃癌住院患者心理状况相关因素的调查分析[J]现代肿瘤医学, 2007,15﹙7﹚: 3401-3405
[16]胡雁Ken Sellick消化道恶性肿瘤患者焦虑和抑郁及生命质量追踪调查[J]中国心理卫生杂志,2003,l7(l2):810-812
[17]王兰英.骨肿瘤患者情绪障碍护理探讨[J].医学论坛杂志,2004,25﹙14﹚:24-25.
[18]徐恩斌,蔡永国,白厚喜消化系恶性肿瘤患者的心理状况及生活质量调查[J]中华现代内科学杂志, 2007 ,4﹙3﹚:216-217
[19]杜树发,施吕元,张惠元,等.前列腺癌患者的生命质量研究[J].中华流行病学杂志,1997,18﹙2﹚:95-97.
[20]齐艳,刘晓虹,沈丽,等.肝癌患者心理状态与个性的评估及分析[J].中华护理杂志, 2004,39﹙2﹚: 153-154
[21] Charles M,Marilyn P, Kirsten T, et al. Predicting psychological distress in patients with leukaemia and lymphoma[J].Psycho Res, 2003,54﹙4﹚:289-292.
[22]韩继明护理心理学[M]北京:清华大学出版社,2006,179
[23]郑瑾,孙田杰,沙儒,等. 317例癌症患者身心需要的调查[J].中华护理杂志,2004,39﹙8﹚:585-587.
[24]闰来荣,魏红艳,张龚,等.癌症患者家庭成员的心理健康状况调查及相关因素分析[J].中国行为医学,2004,13﹙5﹚:514-515.
[25]孙振球徐勇勇医学统计学[M].北京:人民卫生出版社,2006,535
[26]王国强.心身疾病的心理护理原则和目标[J].实用护理杂志,2000,16﹙4﹚:42
[27] Genevieve W R. releases statement on managing pain, depression and fatigue in cancer [J]. Am Fami Physi,2003,67﹙2﹚:423-425.
[28]安丰妹,刁惠民,康丽燕,等.社会心理因素对断指再植术后患者手指功能恢复的影响[J].中华护理杂志,2002,32﹙12﹚:61-62
[29]陈国清,孙青,于洪芳,等.导入心理护理量表与整体护理满意度的相关性研究[J].齐鲁护理杂志,2001,7﹙5﹚:382
[30]郭晓霞,黄唯麟,宋代良,等.血液透析患者性格特征的相关分析及护理对策[J].现代护理,2004,10﹙4﹚:344-346