结直肠癌永久性肠造口患者症状群及症状网络的分析研究-现代医学

结直肠癌永久性肠造口患者症状群及症状网络的分析研究

单位：1. 江西省肿瘤医院, 江西南昌 330029;
2. 南昌大学第一附属医院, 江西南昌 330006

分类号：R473.73

出版年·卷·期（页码）：2026·54·第一期（34-41）

摘要：

目的：系统探究结直肠癌永久性肠造口患者主要症状群的结构特征，识别核心症状与桥梁症状。方法：纳入2023年5月至2024年12月本院就诊的结直肠癌永久性肠造口患者296例为研究对象。采用一般资料、安德森症状评估量表胃肠特异性模块(MDASI-GI)量表调查患者资料。通过探索性因子分析提取症状群；采用R语言软件进行网络分析，通过中心性指标[预期影响(EI)]和桥中心性指标[桥预期影响(BEI)]识别核心症状与桥梁症状。结果：症状发生率较高的是疲乏、腹胀、腹痛/痉挛和困倦，其中疲乏发生率最高(64.86%)，其次为腹胀和腹痛/痉挛。严重程度评分最高前3位仍为疲乏、腹胀、腹痛/痉挛。探索性因子分析共提取出3个症状群，分别为消化道症状群、情绪与精神症状群和全身与感觉症状群。网络分析显示，消化道症状群中相关性最强为腹泻与腹痛/痉挛(r=0.411, P=0.03)，情绪与精神症状群中相关性最强的是困倦与疲乏(r=0.389, P=0.08)，全身与感觉症状群中相关性最强的是麻木/刺痛与气促(r=0.372, P＜0.01)。症状群之间联系最强的是腹痛/痉挛与痛苦/情绪低落(r=0.255,P＜0.01)。EI结果显示，腹痛/痉挛和腹泻为网络的核心症状(EI=4.25、4.28)。BEI结果显示，腹泻、痛苦/情绪低落、麻木或刺痛分别为各自症状群连接其他症状群的桥梁症状(BEI=1.61、1.72、1.73)。结论：结直肠癌永久性肠造口患者的症状分布具有明显群组特征，包含消化道、情绪与精神、全身与感觉3大症状群。腹痛/痉挛、腹泻是网络中的核心症状，腹泻、痛苦/情绪低落、麻木或刺痛分别是各自症状群联通全网的桥梁症状。

Objective: To systematically explore the structural characteristics of major symptom clusters in patients with colorectal cancer-related permanent enterostomy, and to identify core symptoms and bridge symptoms. Methods: A total of 296 patients with colorectal cancer-related permanent enterostomy who attended our hospital from May 2023 to December 2024 were enrolled as research subjects. General demographic data and the M.D. Anderson Symptom Inventory-Gastrointestinal Cancer(MDASI-GI) were used to collect patient information. Exploratory factor analysis was performed to extract symptom clusters. R software was utilized for network analysis, and centrality indicators [expected influence(EI)] and bridge centrality indicators [bridge expected influence(BEI)] were employed to identify core symptoms and bridge symptoms, respectively. Results: The most prevalent symptoms were fatigue, abdominal distension, abdominal pain/cramping, and drowsiness. Among these, fatigue had the highest incidence(64.86%), followed by abdominal distension and abdominal pain/cramping. The top three symptoms with the highest severity scores were also fatigue, abdominal distension, and abdominal pain/cramping. Exploratory factor analysis extracted three symptom clusters: gastrointestinal symptom cluster, emotional and psychological symptom cluster, and systemic and sensory symptom cluster. Network analysis revealed that the strongest correlation within the gastrointestinal symptom cluster was between diarrhea and abdominal pain/cramping(r=0.411, P=0.03); within the emotional and psychological symptom cluster, the strongest correlation was between drowsiness and fatigue(r=0.389, P=0.08); and within the systemic and sensory symptom cluster, the strongest correlation was between numbness/tingling and shortness of breath(r=0.372, P＜0.01). The strongest inter-cluster correlation was observed between abdominal pain/cramping and distress/depression(r=0.255, P＜0.01). EI results indicated that abdominal pain/cramping and diarrhea were the core symptoms of the network(EI=4.25, 4.28). BEI results showed that diarrhea, distress/depression, and numbness/tingling served as bridge symptoms connecting their respective clusters to other clusters(BEI=1.61, 1.72, 1.73). Conclusion: Symptoms in patients with permanent colostomy due to colorectal cancer exhibit distinct clustering characteristics, including three major clusters: gastrointestinal, emotional and psychological, systemic and sensory. Abdominal pain/cramping and diarrhea are the core symptoms of the symptom network, while diarrhea, distress/depression and numbness/tingling act as bridge symptoms linking their respective clusters to the entire network.

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