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系統識別號 U0007-1704200715031712
論文名稱(中文) 乳癌病人放射治療期間的照射劑量、症狀困擾與細胞激素之相關性探討
論文名稱(英文) Relationships among Radiotherapy Dosage, Symptom Distress, and Cytokines in Patients with Breast Cancer
校院名稱 臺北醫學大學
系所名稱(中) 護理學研究所
系所名稱(英) Graduate Institute of Nursing
學年度 94
學期 2
出版年 95
研究生(中文) 周佩君
研究生(英文) Pei-Chun Chou
學號 G455092001
學位類別 碩士
語文別 中文
口試日期
論文頁數 141頁
口試委員 指導教授-林佳靜
中文關鍵字 乳癌  症狀困擾  細胞激素 
英文關鍵字 breast cancer  symptom distress  Cytokines 
學科別分類
中文摘要 本研究之研究目的在於探討乳癌婦女接受放射線治療之劑量、症狀困擾與細胞激素IL-1、IL-6、TNF-α濃度的變化及相關性。採用縱貫式相關性研究設計法,以台灣版安德森症狀量表、台灣版簡明疲憊量表評估及分析乳癌婦女接受放射線治療期間多種的症狀困擾及疲憊症狀嚴重程度,以及症狀困擾對過去24小時日常生活的影響程度及其變化,並使用酵素免疫分析法 (ELISAs)測量細胞激素IL-1、IL-6、TNF-α的濃度變化,使用『廣義估計方程式模式』或稱為『修正模式』(Generalized Estimating Equation model, GEE model)的迴歸分析方法進行相關性分析,經由調整其他相關變項及重複施測的影響來矯正各變項間相依性,探討乳癌婦女放射治療六週間累積劑量、症狀困擾與細胞激素之關聯性。 以方便取樣方式,於北區二所區域教學醫院及一所醫學中心的腫瘤科門診進行收案,共收集12位接受放射線治療的乳癌婦女。本研究發現: 一、乳癌病患放射線治療期間症狀困擾屬輕度困擾、疲憊困擾屬輕度困擾。 二、乳癌婦女接受放射線治療期間最嚴重的症狀困擾依序為『疼痛』、『口乾』、『疲憊』、『睡眠障礙』及『悲傷』。 三、乳癌婦女接受放射線治療之『累積劑量』與『症狀困擾強度』、『疲憊困擾強度』無顯著相關。 四、乳癌婦女接受放射線治療期間照射『累積劑量』與『細胞激素IL-1、IL-6、TNF-α』濃度無顯著相關。 五、乳癌婦女接受放射線治療期間,細胞激素IL-1、IL-6、TNF與『症狀困擾強度』、『疲憊困擾強度』無顯著相關,。 六、乳癌婦女接受放射線治療期間,血中細胞激素TNF-α與疲憊症狀困擾則有顯著負相關。 七、乳癌婦女接受放射線治療期間,控制『時間因素』及『累積劑量』下,血中細胞激素IL-1與症狀困擾中的『疼痛』及『悲傷』症狀有顯著正相關。 八、控制『時間因素』及『累積劑量』下,『細胞激素IL-6』與症狀困擾中的『噁心』呈現顯著負相關。 九、控制『時間因素』及『累積劑量』下,『細胞激素TNF』與症狀困擾中的『疲憊』、『睡眠障礙』呈現顯著負相關。 本研究之結果可以提供及協助醫療照護小組成員瞭解乳癌患者進行放射治療期間的症狀困擾程度及其改變,乳癌病患進行放射線治療期間的細胞激素IL-1、IL-6、TNF與症狀困擾及疲憊症狀有正相關,故建議未來研究可以加入介入措施,例如:音樂治療、放鬆訓練或運動訓練等,比較介入措施對於症狀困擾與細胞激素的變化,同時採用質性研究方法,更可深入探討症狀困擾對於乳癌病患之衝擊。
英文摘要 Cytokines have a major role in cancer-related syndrome. In particular, proinflammatory cytokines interleukin-1 (IL-1), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) may be released as part of host response to tumor or in response to tissue damage or depletion of immune cell subsets associated with cancer treatments. The aim of this study was to assess the level of symptom distress during radiotherapy of breast cancer patients and its relation among symptom distress, serum cytokines, and radiation doses. Twelve patients who received adjuvant radiotherapy without concomitant chemotherapy after Breast-conserving surgery were prospectively studied. Patients rated their cancer-related symptom with two standardized self-assessment instruments, the M.D.Anderson Symptom Inventory-Taiwan Form (MDASI-T) and Brief Fatigue Inventory- Taiwan Form, BFI-Taiwan Form (BFI-T), before radiotherapy, during week 1-5 of treatment, and one week after radiotherapy completion. The serum of cytokines IL-1, IL-6, and TNF-α were determined in parallel to the symptom assessments. Symptom distress measure with the MDASI-T did not increase significantly during treatment, but the subscores on pain intensity were elevated during treatment week 5 and week 6. Radiation doses did not correlate with symptom distress, fatigue, IL-1, IL-6, and TNF-α during therapy. We observed cytokines IL-1 was significantly related to pain and depress. The IL-6 was significantly related to nausea. The TNF-α was significantly related to fatigue and sleep distress. Consequently, this longitudinal prospective study was undertaken to investigate the pattern and duration of symptom distress experienced by individuals with breast cancer during the course of and after treatment with radiation therapy.
論文目次 目 錄 頁 數 致 謝…………………………………………………………… Ι 中文摘要…………………………………………………………… Π 英文摘要…………………………………………………………… Ⅴ 目 錄…………………………………………………………… Ⅶ 圖表目次…………………………………………………………… Ⅹ 第一章 緒論 第一節 研究動機……………………………………………… 1 第二節 研究重要性…………………………………………… 4 第三節 研究目的……………………………………………… 6 第二章 文獻查證 第一節 乳癌的放射線治療…………………………………… 7 第二節 乳癌患者治療期間之症狀困擾……………………… 10 第三節 細胞激素與癌症相關症狀…………………………… 15 第三章 研究方法 第一節 研究假設……………………………………………… 21 第二節 名詞解釋……………………………………………… 22 第三節 研究設計……………………………………………… 27 目 錄 頁數 第四節 研究場所及對象……………………………………… 28 第五節 研究工具……………………………………………… 29 第六節 研究過程……………………………………………… 43 第七節 資料處理與分析……………………………………… 46 第四章 分析與結果 第一節 研究對象的基本資料及疾病特性分析……………… 48 第二節 乳癌病患放射治療期間症狀困擾程度與日常生活干擾程度…………………………………………………… 51 第三節 乳癌病患放射治療期間疲憊困擾及疲憊干擾程度之變化……………………………………………………… 62 第四節 乳癌病患放射治療期間累積劑量及細胞激素之變化………………………………………………………… 67 第五節 乳癌病患放射治療期間累積劑量、症狀困擾與細胞激素之相關性…………………………………………… 73 第五章 討論 第一節 乳癌病患放射治療期間之症狀困擾程度及其改變… 104 第二節 乳癌病患放射治療期間之疲憊症狀及其改變……… 107 目 錄 頁數 第三節乳癌病患放射治療期間之累積劑量、症狀困擾與細胞激素之相關性…………………………………………… 109 第六章 結論與建議 第一節 結論…………………………………………………… 112 第二節 研究限制……………………………………………… 114 第三節 建議…………………………………………………… 116 參考資料 中文部份………………………………………………………… 119 英文部份………………………………………………………… 121 附錄 附錄一 研究同意書……………………………………………… 131 附錄二 個案基本資料(一)……………………………………… 133 附錄三 個案基本資料(二)……………………………………… 134 附錄四 臺灣版安德森症狀量表(MDASI-T)量表…………… 135 附錄五 台灣版簡明疲憊量表(BFI-T)量表…………………… 137 附錄六 人體試驗研究計劃申請書……………………………… 138 附錄七 醫院臨床(人體)試驗受試者同意書…………………… 139 圖 表 目 次 頁數 圖一、細胞激素與癌症相關症狀…………………………… 19 圖二、研究架構……………………………………………… 20 圖三、酵素免疫分析法實驗過程…………………………… 40 圖四、細胞激素測量儀器(ELISA reader) …………………… 41 圖五、酵素的呈色反應……………………………………… 42 圖六、研究步驟流程圖……………………………………… 45 圖七、乳癌患者放射治療期間之症狀強度分佈…………… 53 圖八、乳癌患者放射治療期間之症狀困擾嚴重程度變化……………………………………………………… 61 圖九、乳癌病患放射治療期間疲憊症狀困擾嚴重程度分佈 66 圖十、乳癌婦女放射治療期間治療期間細胞激素IL-1變化分佈……………………………………………………… 70 圖十一、乳癌婦女放射治療期間治療期間細胞激素IL 71 圖十二、乳癌婦女放射治療期間治療期間細胞激素TNF變化分佈………………………………………………… 72 圖十三、累積劑量與症狀困擾強度相關性散佈圖………… 77 圖 表 目 次 頁數 圖十四、累積劑量與疲憊症狀困擾強度相關性散佈圖…… 78 圖十五、累積劑量與細胞激素IL-1相關性散佈圖………… 79 圖十六、累積劑量與細胞激素IL-6相關性散佈圖………… 80 圖十七、累積劑量與細胞激素TNF相關性散佈圖………… 81 圖十八、細胞激素IL-1與症狀強度相關性散佈圖………… 85 圖十九、細胞激素IL-1與疲憊症狀強度相關性散佈圖…… 86 圖二十、細胞激素IL-1與疼痛症狀相關性散佈圖………… 87 圖二十一、細胞激素IL-1與悲傷症狀相關性散佈圖……… 88 圖二十二、細胞激素IL-6與症狀強度相關性散佈圖……… 91 圖二十三、細胞激素IL-6與疲憊症狀相關性散佈圖……… 92 圖二十四、細胞激素TNF與症狀強度相關性散佈圖……… 97 圖二十五、細胞激素TNF與疲憊症狀強度相關性散佈圖… 98 圖二十六、細胞激素TNF與疲勞症狀相關性散佈圖……… 99 圖二十七、細胞激素TNF與睡眠障礙症狀相關性散佈圖… 100 圖 表 目 次 頁數 表一、細胞激素的變化與癌症相關症狀…………………… 18 表二、細胞激素IL-1、IL-6及TNF-α之來源與功能……… 23 表三、臺灣版、美國版、日文版及中文版安德森症狀量表(MDASI)之Cronbach’s α一覽表…………………… 35 表四、研究資料收集表……………………………………… 44 表五、資料統計分析方法…………………………………… 47 表六、研究個案基本屬性…………………………………… 49 表七、研究個案疾病與治療特性…………………………… 50 表八、乳癌患者放射治療期間之症狀強度與日常生活干擾強度…………………………………………………… 52 表九、乳癌患者放射治療期間之疲憊症狀困擾…………… 65 表十、乳癌病患放射治療期間平均累積劑量……………… 68 表十一、乳癌婦女放射治療期間細胞激素變化…………… 69 表十二、累積劑量與症狀困擾、細胞激素之相關分析……… 76 表十三、控制時間及累積劑量乳癌患者放射治療之症狀困擾與細胞激素IL-1之G.E.E相關性分析…………… 84 圖 表 目 次 頁數 表十四、控制時間及累積劑量乳癌患者放射治療之症狀困擾與細胞激素IL-6之G.E.E相關性分析……………… 93 表十五、控制時間及累積劑量乳癌患者放射治療之症狀困擾與細胞激素TNF之G.E.E相關性分析…………… 96
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