曾晓敏 杨伟斌

[摘要] 目的 探討认知行为治疗对乳腺癌术后化疗患者心理状态及细胞免疫功能的影响。 方法 选择2014年1月～2017年8月乳腺癌术后化疗患者70例，随机分为干预组与对照组。两组均行CMF方案化疗，对照组化疗期间予以常规干预，干预组在对照组基础上予认知行为治疗。两组均干预3个月。观察并比较两组治疗前后心理状态及细胞免疫功能的变化。 结果 干预3个月后，两组的SDS和SAS评分均较干预前不同程度下降（P<0.05或P<0.01），且治疗后干预组SDS和SAS评分低于对照组（P<0.05）；同时干预组CD4+水平和CD4+/CD8+比值均较干预前不同程度上升，CD8+水平均较干预前不同程度下降（P<0.05或P<0.01），而对照组干预前后无明显变化（P>0.05）。治疗后干预组CD4+水平和CD4+/CD8+比值高于对照组，CD8+水平低于对照组（P<0.05或P<0.01）。 结论 认知行为治疗用于乳腺癌术后化疗患者的效果肯定，不仅可显著改善其心理状态，缓解其抑郁及焦虑状态；而且能调节T淋巴细胞亚群紊乱，增强其细胞免疫功能。

[关键词] 乳腺癌；术后化疗；认知行为治疗；心理状态；细胞免疫

[中图分类号] R473.73；R730.53 [文献标识码] B [文章编号] 1673-9701（2018）15-0094-04

Effect of cognitive behavioral therapy on mental status and cellular immune function in breast cancer patients with postoperative chemotherapy

ZENG Xiaomin1 YANG Weibin2

1.Department of Thyroid and Breast Surgery， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China； 2.Department of Radiology， Lishui Central Hospital in Zhejiang Province， Lishui 323000， China

[Abstract] Objective To investigate the effect of cognitive behavioral therapy on psychological status and cellular immune function in patients with postoperative chemotherapy of breast cancer. Methods 70 breast cancer patients with postoperative chemotherapy from January 2014 to August 2017 were randomly divided into intervention group and control group. Both groups underwent CMF chemotherapy. The control group received routine intervention during the chemotherapy， and the intervention group received cognitive behavioral therapy on the basis of the treatment of the control group. Both groups were intervened for 3 months. The changes of psychological status and cellular immune function before and after treatment between two groups were observed and compared. Results The SDS and SAS scores of both groups decreased to different degrees after 3 months of intervention（P<0.05 or P<0.01）， and SDS and SAS scores in the intervention group were lower than those of control group（P<0.05）. The levels of CD4+ and the ratio of CD4+/ CD8+ in the intervention group increased at different degrees， and the levels of CD8+ in the intervention group decreased to different degrees （P<0.05 or P<0.01）， while those in the control group did not change significantly （P>0.05）. After treatment， the level of CD4+ and the ratio of CD4+/CD8+ in intervention group was higher than that in control group， and the level of CD8+ in the intervention group was lower than that in control group（P<0.05 or P<0.01）. Conclusion Cognitive behavioral therapy is effective for patients with postoperative chemotherapy of breast cancer， which not only can significantly improve their psychological status and relieve their depression and anxiety states， but also regulate the disturbance of T lymphocyte subsets and enhance the cellular immune function.

[Key words] Breast cancer； Postoperative chemotherapy； Cognitive behavioral therapy； Psychological status； Cellular immunity

乳腺癌是女性最常见的恶性肿瘤之一，手术切除是目前治疗的首选方法，术后常需行化疗[1，2]。乳腺癌在化疗期间不仅可出现不同程度的焦虑与恐惧等心理障碍，影响其治疗依从性，而且还可以出现免疫功能低下，从而降低机体对癌细胞的识别和杀伤能力，影响其化疗效果[3，4]。认知行为疗法是一组通过改变思维或信念的方法来改变不良行为，达到消除心理障碍和行为的治疗方法，近年来应用于乳腺癌化疗患者发现其具有改善患者心理状态的作用，但其对免疫功能的影响报道较少[5，6]。本研究观察了认知行为治疗对乳腺癌术后化疗患者心理状态及细胞免疫功能的影响，现报道如下。

1 资料与方法

1.1 一般资料

选择2014年1月～2017年8月在我院行乳腺癌术后化疗患者70例。纳入标准：（1）乳腺癌根治术后首次拟行CMF方案化疗；……