中药配合心理干预方案提高肿瘤患者生活质量的初步研究
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摘要
目的:综合治疗是目前治疗恶性肿瘤的主要方法,其中中医药在综合治疗中的地位日显凸出。虽然中医心理干预治疗恶性肿瘤有一定疗效,然而缺乏规范化治疗方案及疗效标准,尚未在临床中得到广泛应用。本课题旨在客观评价中药配合中医心理干预方案在改善肿瘤患者心理状态、调节免疫功能及提高生活质量等方面的临床疗效,并试图为完善恶性肿瘤综合治疗,并形成初步的规范化心理治疗方案提供临床依据。
方法:通过前瞻性随机对照临床研究,以心理状态评分(Hamilton抑郁自评量表计分)、免疫功能(NK、T细胞亚群)检测指标和生活质量计分(EORTC QLQ-C30(version 3)生活质量调查问卷)为重点研究指标,在北京中医药大学东直门医院和中国医学科学院肿瘤医院观察了符合纳入病例标准的53例恶性肿瘤患者,按不平衡指数最小的分配原则,随机分配到治疗组及对照组,两组比例为1:1。对照组:采用常规治疗,包括化疗、对症治疗和支持治疗等。治疗组:在对照组治疗基础上,增加中药配合中医心理干预疗法。全部病例均连续治疗14天为一个治疗周期。每组分别观察治疗1个周期。统计分析采用SPSS11.0统计分析软件进行计算。组间资料两两比较采用t检验。治疗前后比较用配对t检验。
结果:中医心理干预方案对于改善肿瘤患者的心理状态、生活质量具有明显作用,在情感关系、免疫指标等方面的改善较对照组均有统计学意义。①中医心理干预治疗组第8天测评,与疗前比较,Hamilton评分有所上升,但无统计学意义(P>0.05);第15天测评,Hamilton评分明显下降,与疗前相比有统计学意义(P<0.01)。而常规治疗对照组中,疗后两次测评与治疗前比较,Hamilton评分略有上升,无统计学意义。②中医心理干预治疗组第8天测评,8例QOL明显改善,与对照组(仅1例改善)比较,具有统计学意义(P<0.01);第15天测评,治疗组QOL评分明显上升,生活质量明显提高者达到22例,与常规治疗对照组(QOL改善者仅有2例)相比,有效率分别为75.9%和8.3%,具有统计学意义(P<0.001)。③中医心理干预治疗组第15天测评免疫功能,治疗组与对照组相比,CD3+、CD4+、CD4+/CD8+均上升,CD8+下降,具有统计学意义(P<0.05),治疗组NK细胞疗后虽比对照组上升,但无统计学意义(P>0.05);治疗组治疗前、疗后相比,CD3+、CD4+、CD4+/CD8+均上升,CD8+下降,具有统计学意义(P<0.05)。
结论:以调畅情志为主的中医心理干预治疗可以作为肿瘤综合治疗的一部分,对提高肿瘤患者生活质量方面大有裨益,反映出中药配合心理治疗方案在一定程度上调节机体免疫功能的一种趋势。本课题的研究结果显示中医心理治疗可以使肿瘤患者心理状态改善,生活质量提高,免疫指标好转,三者之间存在直接相关性。提示在肿瘤患者综合治疗中,中药配合心理干预疗法不但有助于控制肿瘤的发展,还具有一定的社会和经济效应,该方案值得进一步探索与完善。
Purpose In the prospective, random control study the author aimed to objectively evaluate the therapeutic effect of traditional Chinese medicine combined with mental intervention therapy (TCM mental intervention therapy) on improving mental status, regulating immune function and elevating quality of life(QOL) of tumor patients. Furthermore, it is hoped that the study to be helpful for preliminarily forming the therapy of standardized psychotherapy of TCM, which may provide clinical data for consummating combined therapy of tumor.
Methods 53 cases of tumor patients were observed in Dongzhimen Hospital and Cancer hospital of Chinese Academy of Medical Sciences.Taking mental status score, immune function index and evaluation of QOL as focal points, it was intensively explored the mechanism of TCM with mental intervention therapy interrupting tumor development, i.e. to control tumor by means of regulating the immune state of the patients, and more to improve QOL of the patients to draw assistance from changing the mental status.
Results TCM mental intervention therapy indicates obvious effect in the different aspects of mental status, immune function and quality of life. Compared with the control group the study showed notable statistical difference on the index of mentation and immune function. PartⅠHamilton Score. In the group of TCM mental intervention therapy, day 8th survey indicated that Hamilton Score was slightly increased compared with day 1st(P value>0.05). While day 15th survey showed that Hamilton Score was notably decreased compared with day 1st(P value<0.01). On the contrary, in the group which utilized routine therapy the both surveies on day 8th and 15th Hamilton Score was slightly increased compared with day 1st(P value>0.05).PartⅡQOL Index. In the group of TCM mental intervention therapy, day 8th survey indicated that quality of life of 8 cases was obviously improveed compared with control group (P value<0.05). Day 15th survey showed that QOL Index was notably decreased compared with day 1st, 22 cases among which QOLwere notably improved while in control group,only 2 cases, the effective ratio was 75.9% to 8.3% (P value<0.001). PartⅢImmune function. Part of cases in the group of TCM mental intervention therapy showed immune functional recovery.
Conclusion TCM mental intervention therapy which stresses on regulating and smoothing mentation of tumor patients is much helpful for improving QOL and, in certain extent, the therapy could regulate immune fuction. Results of the study demonstrate that the therapy of TCM mental intervention improving mental status, recovering immune function and elevating quality of life of tumor patients, the three aspects are directly correlated, therefore TCM mental intervention therapy, as a part of combined therapy of tumor, makes for control tumor development and need further study.
方法:通过前瞻性随机对照临床研究,以心理状态评分(Hamilton抑郁自评量表计分)、免疫功能(NK、T细胞亚群)检测指标和生活质量计分(EORTC QLQ-C30(version 3)生活质量调查问卷)为重点研究指标,在北京中医药大学东直门医院和中国医学科学院肿瘤医院观察了符合纳入病例标准的53例恶性肿瘤患者,按不平衡指数最小的分配原则,随机分配到治疗组及对照组,两组比例为1:1。对照组:采用常规治疗,包括化疗、对症治疗和支持治疗等。治疗组:在对照组治疗基础上,增加中药配合中医心理干预疗法。全部病例均连续治疗14天为一个治疗周期。每组分别观察治疗1个周期。统计分析采用SPSS11.0统计分析软件进行计算。组间资料两两比较采用t检验。治疗前后比较用配对t检验。
结果:中医心理干预方案对于改善肿瘤患者的心理状态、生活质量具有明显作用,在情感关系、免疫指标等方面的改善较对照组均有统计学意义。①中医心理干预治疗组第8天测评,与疗前比较,Hamilton评分有所上升,但无统计学意义(P>0.05);第15天测评,Hamilton评分明显下降,与疗前相比有统计学意义(P<0.01)。而常规治疗对照组中,疗后两次测评与治疗前比较,Hamilton评分略有上升,无统计学意义。②中医心理干预治疗组第8天测评,8例QOL明显改善,与对照组(仅1例改善)比较,具有统计学意义(P<0.01);第15天测评,治疗组QOL评分明显上升,生活质量明显提高者达到22例,与常规治疗对照组(QOL改善者仅有2例)相比,有效率分别为75.9%和8.3%,具有统计学意义(P<0.001)。③中医心理干预治疗组第15天测评免疫功能,治疗组与对照组相比,CD3+、CD4+、CD4+/CD8+均上升,CD8+下降,具有统计学意义(P<0.05),治疗组NK细胞疗后虽比对照组上升,但无统计学意义(P>0.05);治疗组治疗前、疗后相比,CD3+、CD4+、CD4+/CD8+均上升,CD8+下降,具有统计学意义(P<0.05)。
结论:以调畅情志为主的中医心理干预治疗可以作为肿瘤综合治疗的一部分,对提高肿瘤患者生活质量方面大有裨益,反映出中药配合心理治疗方案在一定程度上调节机体免疫功能的一种趋势。本课题的研究结果显示中医心理治疗可以使肿瘤患者心理状态改善,生活质量提高,免疫指标好转,三者之间存在直接相关性。提示在肿瘤患者综合治疗中,中药配合心理干预疗法不但有助于控制肿瘤的发展,还具有一定的社会和经济效应,该方案值得进一步探索与完善。
Purpose In the prospective, random control study the author aimed to objectively evaluate the therapeutic effect of traditional Chinese medicine combined with mental intervention therapy (TCM mental intervention therapy) on improving mental status, regulating immune function and elevating quality of life(QOL) of tumor patients. Furthermore, it is hoped that the study to be helpful for preliminarily forming the therapy of standardized psychotherapy of TCM, which may provide clinical data for consummating combined therapy of tumor.
Methods 53 cases of tumor patients were observed in Dongzhimen Hospital and Cancer hospital of Chinese Academy of Medical Sciences.Taking mental status score, immune function index and evaluation of QOL as focal points, it was intensively explored the mechanism of TCM with mental intervention therapy interrupting tumor development, i.e. to control tumor by means of regulating the immune state of the patients, and more to improve QOL of the patients to draw assistance from changing the mental status.
Results TCM mental intervention therapy indicates obvious effect in the different aspects of mental status, immune function and quality of life. Compared with the control group the study showed notable statistical difference on the index of mentation and immune function. PartⅠHamilton Score. In the group of TCM mental intervention therapy, day 8th survey indicated that Hamilton Score was slightly increased compared with day 1st(P value>0.05). While day 15th survey showed that Hamilton Score was notably decreased compared with day 1st(P value<0.01). On the contrary, in the group which utilized routine therapy the both surveies on day 8th and 15th Hamilton Score was slightly increased compared with day 1st(P value>0.05).PartⅡQOL Index. In the group of TCM mental intervention therapy, day 8th survey indicated that quality of life of 8 cases was obviously improveed compared with control group (P value<0.05). Day 15th survey showed that QOL Index was notably decreased compared with day 1st, 22 cases among which QOLwere notably improved while in control group,only 2 cases, the effective ratio was 75.9% to 8.3% (P value<0.001). PartⅢImmune function. Part of cases in the group of TCM mental intervention therapy showed immune functional recovery.
Conclusion TCM mental intervention therapy which stresses on regulating and smoothing mentation of tumor patients is much helpful for improving QOL and, in certain extent, the therapy could regulate immune fuction. Results of the study demonstrate that the therapy of TCM mental intervention improving mental status, recovering immune function and elevating quality of life of tumor patients, the three aspects are directly correlated, therefore TCM mental intervention therapy, as a part of combined therapy of tumor, makes for control tumor development and need further study.
引文
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5 Cohen S, Herbert TB. Health psychology: psychological factors and physical disease from the perspective of human Psychoneuroimmunology. Annul Review Psychology,1996,47:113-42
6 Baltrusch HJ, Stangel W, Titze I. Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research. Acta Neurol (Napoli). 1991 Aug;13(4):315-27.
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22 Bauer SM. Psychoneuroimmunology and cancer: an integrated review. J Adv Nurs. 1994 Jun;19(6):1114-20.
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25 Schmale AH. Clinical trials in psychosocial medicine: methodologic and statistical considerations. Part I. Introduction. Cancer Treat Rep. 1980 Feb-Mar;64(2-3):441-3.
26 Gross J.Emotional expression in cancer onset and progression.Soc Sci Med. 1989;28(12):1239-48. Review.
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28 Wirsching M.Psychosomatics of breast cancer - present state of research and new developments Psychosom Med Psychoanal. 1979 Jul-Sep;25(3):240-50. German.
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30 Palermo NJ,Oliveira D,Massoco C,et al.Effects of physical and psychological stressors on behavior,macrophage activity,and Ehrlich tumorgrowth.Brain,Behavior and Immunity 2003;17(1):43-54
31 Kano J et al. Mech Ageing Dev 1997,93(1-3)107-117
32 Anderson BL,et al. J Natl Cancer Inst 1998,90 (1):30-36
33 Vander G, et al. Biol Psychol 1998,48(1):21-35
34 Ishihara Y, et al. Psychoneuroemdocrinology 1999,24(7):713-726
35 杨钢主编 内分泌生理与病理生理学,天津科学技术出版社,1996 :P786
36 高成阁,周芙玲,魏永长,南克俊 心理社会因素与肿瘤细胞免疫研究进展 国外医学 社会医学分册2002.04.43
37 Todarello O, et al. Psychosom 1997,66(4):108-113
38 Dewarajia R, et al. Psychother Psychosom 1997,66(2):83-86
39 Wu W et al. Life Sci 2000,66(19):1827-1838
40 Lekander M et al. Psychother Psychosom 1997,66(4):185-191
41 Allen TG et al. J R Soc Med. 1998,91(8):408-413
42 Dekeyser FG et al. Oncol Nurse Forum 1998 Sep 25(8):1415-1422
43 Holden RJ, et al. Med Hypotheses 1998,51(4):309-314
44 Capuron L et al. J Clin Oncol 2000,18(10):2143-2151
45 郑伯华,陈建平,扬帆等.消化道癌症病人心理反应和细胞免疫的研究中国行为医学科学 1999.8.(3).34
46 孙士友,舒良,尚兰等.抑郁症的免疫学研究进展. 中国心理卫生杂志,1997, 11: 112-114.
47 王建平,林文娟,梁耀坚等.心理干预对癌症患者免疫功能的影响 中国肿瘤临床 2002,29(12):841-844
48 马博,李中琦,马志敏.消化系统癌症病人抑郁情绪和细胞免疫的研究 中国行为医学科学 2002,11(1):49-50
49 Devries MJ, et al. Psychooncology 1997,6(2):129-137
50 Shekelle RB, Raynor WJ Jr, Ostfeld AM, Garron DC, Bieliauskas LA, Liu SC, Maliza C, Paul O. Psychological depression and 17-year risk of death from cancer. Psychosom Med. 1981 Apr;43(2):117-25.
51 张理义,金国元,李斌等.消化道癌与正常人神经内分泌、免疫功能及社会心理因素的研究. 中国行为医学科学,1997,6(1):42-4
53 52 Burnet K, Robinson L. Psychosocial impact of recurrent cancer.Eur J Oncol Nurs. 2000 Mar;4(1):29-38.
54 王米渠、王克勤等主编:中医心理学,湖北科学技术出版社,1987.72—79
55 张伯华主编:中医心理学,科学出版社,1995.224
56 张日昇主编:咨询心理学,人民教育出版社,1999.346-410 临床医学杂志 > 2005 年 > 15 期
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8 曾莹,胡超英.癌症患者心理障碍分析与护理干预.护理学杂志 2000.10.32
9 江敏霞, 黄华兰.癌症放疗患者心理障碍原因分析和护理 南方护理学报 2004.05.23
10 Leshan L. An emotional life-history pattern associated with neoplastic disease. Ann N Y Acad Sci. 1966 Jan 21;125(3):780-93. No abstract available.
11 Bauer SM. Psychoneuroimmunology and cancer: an integrated review. J Adv Nurs. 1994 Jun;19(6):1114-20.
12 蔡礼鸣,蔡映去,李德仁,等. 不良生活事件和应对方式与肺癌发病关系的研究.(J) 中国行为医学科学,1998.7(2) :129-131
13 Temoshok L, Heller BW, Sagebiel RW, Blois MS, Sweet DM, DiClemente RJ, Gold ML. The relationship of psychosocial factors to prognostic indicators in cutaneous malignant melanoma. J Psychosom Res. 1985;29 (2):139-53.
14 Schmale AH. Clinical trials in psychosocial medicine: methodologic and statistical considerations. Part I. Introduction. Cancer Treat Rep. 1980 Feb-Mar;64(2-3):441-3.
15 Gross J.Emotional expression in cancer onset and progression.Soc Sci Med. 1989;28(12):1239-48. Review.
16 Geer KP, Ropka ME, Cohn WF, Jones SM, Miesfeldt S.Factors influencing patients' decisions to decline cancer genetic counseling services.J Genet Couns. 2001 Feb;10(1):25-40.
17 Wirsching M.Psychosomatics of breast cancer - present state of research and new developments Psychosom Med Psychoanal. 1979 Jul-Sep;25(3):240-50. German.
18 Shekelle RB, Raynor WJ Jr, Ostfeld AM, Garron DC, Bieliauskas LA, Liu SC, Maliza C, Paul O. Psychological depression and 17-year risk of death from cancer. Psychosom Med. 1981 Apr;43(2):117-25.
19 张理义,金国元,李斌等 消化道癌与正常人神经内分泌、免疫功能及社会心理因素的研究. 中国行为医学科学,1997,6(1):42-4
20 Burnet K, Robinson L. Psychosocial impact of recurrent cancer.Eur J Oncol Nurs. 2000 Mar;4(1):29-38.
21 Baltrusch HJ, Stangel W, Titze I. Stress, cancer and immunity. New developments inbiopsychosocial and psychoneuroimmunologic research. Acta Neurol (Napoli). 1991 Aug;13(4):315-27.
22 Bovbjerg DH. Psychoneuroimmunology. Implications for oncology? Cancer. 1991 Feb 1;67(3 Suppl):828-32.
23 Evans WP, Starr AL, Bennos ES.Comparison of the relative incidence of impalpable invasive breast carcinoma and ductal carcinoma in situ in cancers detected in patients older and younger than 50 yrs of age.Radiology. 1997 Aug; 204(2):489-91
24 Gordan WA, Freidenbergs I. Efficacy of psycosocial interventions with cancer patients. Journal of Consult Psycology,1980,(48):743-759
25 Gottschalk LA,Fronczek J,Buchsbaum MS. The cerebral neurobiology of hope and hopelessness. Psychiatry,1993,AU,56(3):270-281
26 Cohen S, Herbert TB. Health psychology: psychological factors and physical disease from the perspective of human Psychoneuroimmunology. Annul Review Psychology,1996,47:113-42
27 杨镇主编.肿瘤免疫学 湖北科学技术出版社,1998.10 6
28 Terzolo M, Reimondo G, Ali A, Bovio S, Daffara F, Paccotti P, Angeli A. Ectopic ACTH syndrome: molecular bases and clinical heterogeneity. Ann Oncol. 2001;12 Suppl 2:S83-7. Review.
29 Bhatavdekar JM, Patel DD, Vora HH, Shah NG, Karelia NH, Ghosh N, Balar DB. Prolactin: its role in advanced tongue cancer.J Surg Oncol. 1994 Oct;57(2):115-20.
30 Kano J et al. Mech Ageing Dev 1997,93(1-3)107-117
31 Anderson BL,et al. J Natl Cancer Inst 1998,90 (1):30-36
32 Vander G, et al. Biol Psychol 1998,48(1):21-35
33 Ishihara Y, et al. Psychoneuroemdocrinology 1999,24(7):713-726
34 Todarello O, et al. Psychosom 1997,66(4):108-113
35 Dewarajia R, et al. Psychother Psychosom 1997,66(2):83-86
36 Wu W et al. Life Sci 2000,66(19):1827-1838
37 Lekander M et al. Psychother Psychosom 1997,66(4):185-191
38 Allen TG et al. J R Soc Med. 1998,91(8):408-413
39 Dekeyser FG et al. Oncol Nurse Forum 1998 Sep 25(8):1415-1422
40 Holden RJ, et al. Med Hypotheses 1998,51(4):309-314
41 Capuron L et al. J Clin Oncol 2000,18(10):2143-2151
42 郑伯华,陈建平,扬帆等.消化道癌症病人心理反应和细胞免疫的研究中国行为医学科学 1999 8 (3)89-96
43 孙士友,舒良,尚兰等.抑郁症的免疫学研究进展. 中国心理卫生杂志,1997, 11: 112-114.
44 王建平,林文娟,梁耀坚等.心理干预对癌症患者免疫功能的影响 中国肿瘤临床2002,29(12):841-844
45 马博,李中琦,马志敏.消化系统癌症病人抑郁情绪和细胞免疫的研究 中国行为医学科学 2002,11(1):49-50
46 Devries MJ, et al. Psychooncology 1997,6(2):129-137
47 胡随瑜,张宏耕,郑林,等.1977 例抑郁症患者中医不同证型构成比分析.中国医师杂志,2003,5(10):1312-1314.
48 李佩文主编.中西医临床肿瘤学 中国中医药出版社 1996.12 141
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2 Evans WP, Starr AL, Bennos ES.Comparison of the relative incidence of impalpable invasive breast carcinoma and ductal carcinoma in situ in cancers detected in patients older and younger than 50 yrs of age.Radiology. 1997 Aug; 204(2):489-91
3 Gordan WA, Freidenbergs I. Efficacy of psycosocial interventions with cancer patients. Journal of Consult Psycology,1980,(48):743-759
4 Gottschalk LA,Fronczek J,Buchsbaum MS. The cerebral neurobiology of hope and hopelessness. Psychiatry,1993,AU,56(3):270-281
5 Cohen S, Herbert TB. Health psychology: psychological factors and physical disease from the perspective of human Psychoneuroimmunology. Annul Review Psychology,1996,47:113-42
6 Baltrusch HJ, Stangel W, Titze I. Stress, cancer and immunity. New developments in biopsychosocial and psychoneuroimmunologic research. Acta Neurol (Napoli). 1991 Aug;13(4):315-27.
7 Bovbjerg DH. Psychoneuroimmunology. Implications for oncology? Cancer. 1991 Feb 1;67(3 Suppl):828-32.
8 杨镇 肿瘤免疫学 湖北科学技术出版社,1998.10 6
9 Terzolo M, Reimondo G, Ali A, Bovio S, Daffara F, Paccotti P, Angeli A. Ectopic ACTH syndrome: molecular bases and clinical heterogeneity. Ann Oncol. 2001;12 Suppl 2:S83-7. Review.
10 Bhatavdekar JM, Patel DD, Vora HH, Shah NG, Karelia NH, Ghosh N, Balar DB. Prolactin: its role in advanced tongue cancer.J Surg Oncol. 1994 Oct;57(2):115-20.
11 乐国庆主编:咨询心理学,南开大学出版社 2002 121--158
12 吴宗群,解建国.补中益气汤提高机体免疫力的实验研究进展 中成药 2002.1.43
13 清水昌寿,等.サルモネラ菌感染モデルヌゥス作咸と補中益气汤こょゐ免疫調節治瘵.の試み[J].中国中医基础医学杂志,1997,3(2):19～20 [6]
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17 周爱武.香菇多糖的免疫调节作用.中国药理学通报,1995,11(2):157
18 秦凤华.谢蜀生,龙振洲,等.雷公藤总甙免疫抑制作用机制.中国药理学通报,1991,7(6):433
19 董彦章,蒋明,朱立平,等.雷公藤多甙对人淋巴细胞 IL-2 自泌环路的抑制作用.中国医学科学院学报,1993,15(3):193
20 黄丽,罗健主编 肿瘤心理治疗,人民卫生出版社 2000.4 104
21 Leshan L. An emotional life-history pattern associated with neoplastic disease. Ann N Y Acad Sci. 1966 Jan 21;125(3):780-93. No abstract available.
22 Bauer SM. Psychoneuroimmunology and cancer: an integrated review. J Adv Nurs. 1994 Jun;19(6):1114-20.
23. 蔡礼鸣,蔡映去,李德仁,等. 不良生活事件和应对方式与肺癌发病关系的研究.(J) 中国行为医学科学,1998.7(2) :129-131
24 Temoshok L, Heller BW, Sagebiel RW, Blois MS, Sweet DM, DiClemente RJ, Gold ML. The relationship of psychosocial factors to prognostic indicators in cutaneous malignant melanoma. J Psychosom Res. 1985;29 (2):139-53.
25 Schmale AH. Clinical trials in psychosocial medicine: methodologic and statistical considerations. Part I. Introduction. Cancer Treat Rep. 1980 Feb-Mar;64(2-3):441-3.
26 Gross J.Emotional expression in cancer onset and progression.Soc Sci Med. 1989;28(12):1239-48. Review.
27 Geer KP, Ropka ME, Cohn WF, Jones SM, Miesfeldt S.Factors influencing patients' decisions to decline cancer genetic counseling services.J Genet Couns. 2001 Feb;10(1):25-40.
28 Wirsching M.Psychosomatics of breast cancer - present state of research and new developments Psychosom Med Psychoanal. 1979 Jul-Sep;25(3):240-50. German.
29 郭庆秋,颜军,孙开宏,等.运动训练对心理应激机体肿瘤坏死因子 α 的影响[J].中国临床康复,2005,9(8):142-3
30 Palermo NJ,Oliveira D,Massoco C,et al.Effects of physical and psychological stressors on behavior,macrophage activity,and Ehrlich tumorgrowth.Brain,Behavior and Immunity 2003;17(1):43-54
31 Kano J et al. Mech Ageing Dev 1997,93(1-3)107-117
32 Anderson BL,et al. J Natl Cancer Inst 1998,90 (1):30-36
33 Vander G, et al. Biol Psychol 1998,48(1):21-35
34 Ishihara Y, et al. Psychoneuroemdocrinology 1999,24(7):713-726
35 杨钢主编 内分泌生理与病理生理学,天津科学技术出版社,1996 :P786
36 高成阁,周芙玲,魏永长,南克俊 心理社会因素与肿瘤细胞免疫研究进展 国外医学 社会医学分册2002.04.43
37 Todarello O, et al. Psychosom 1997,66(4):108-113
38 Dewarajia R, et al. Psychother Psychosom 1997,66(2):83-86
39 Wu W et al. Life Sci 2000,66(19):1827-1838
40 Lekander M et al. Psychother Psychosom 1997,66(4):185-191
41 Allen TG et al. J R Soc Med. 1998,91(8):408-413
42 Dekeyser FG et al. Oncol Nurse Forum 1998 Sep 25(8):1415-1422
43 Holden RJ, et al. Med Hypotheses 1998,51(4):309-314
44 Capuron L et al. J Clin Oncol 2000,18(10):2143-2151
45 郑伯华,陈建平,扬帆等.消化道癌症病人心理反应和细胞免疫的研究中国行为医学科学 1999.8.(3).34
46 孙士友,舒良,尚兰等.抑郁症的免疫学研究进展. 中国心理卫生杂志,1997, 11: 112-114.
47 王建平,林文娟,梁耀坚等.心理干预对癌症患者免疫功能的影响 中国肿瘤临床 2002,29(12):841-844
48 马博,李中琦,马志敏.消化系统癌症病人抑郁情绪和细胞免疫的研究 中国行为医学科学 2002,11(1):49-50
49 Devries MJ, et al. Psychooncology 1997,6(2):129-137
50 Shekelle RB, Raynor WJ Jr, Ostfeld AM, Garron DC, Bieliauskas LA, Liu SC, Maliza C, Paul O. Psychological depression and 17-year risk of death from cancer. Psychosom Med. 1981 Apr;43(2):117-25.
51 张理义,金国元,李斌等.消化道癌与正常人神经内分泌、免疫功能及社会心理因素的研究. 中国行为医学科学,1997,6(1):42-4
53 52 Burnet K, Robinson L. Psychosocial impact of recurrent cancer.Eur J Oncol Nurs. 2000 Mar;4(1):29-38.
54 王米渠、王克勤等主编:中医心理学,湖北科学技术出版社,1987.72—79
55 张伯华主编:中医心理学,科学出版社,1995.224
56 张日昇主编:咨询心理学,人民教育出版社,1999.346-410 临床医学杂志 > 2005 年 > 15 期