症状困扰对中青年胶质瘤患者癌症复发恐惧的影响：社会疏离与元认知的链式中介作用-现代医学

症状困扰对中青年胶质瘤患者癌症复发恐惧的影响：社会疏离与元认知的链式中介作用

单位：南京医科大学附属脑科医院神经外科, 江苏南京 210029

分类号：R739.41;R473.6

出版年·卷·期（页码）：2025·53·第十期（1619-1625）

摘要：

目的：探讨中青年胶质瘤患者社会疏离与元认知在症状困扰与癌症复发恐惧(FCR)之间的链式中介作用，为制定心理干预策略提供理论依据。方法：采用横断面研究设计，选取2022年4月至2024年10月于本院神经外科行手术治疗的中青年胶质瘤患者为研究对象。采用一般资料调查表、安德森症状评估量表(MDASI)、一般疏离感量表(GSA)、元认知问卷(MCQ-30)和短版癌症复发恐惧量表(FCRI-SF)进行问卷调查。采用单因素分析筛选中青年胶质瘤患者FCR的危险因素，Pearson分析变量间的相关性；采用PROCESS插件(模型6)进行链式中介效应分析。结果：患者FCRI-SF得分为(14.97±4.84)分，64.74%的患者FCRI-SF得分≥13分。单因素分析结果表明，年龄≤40岁、初中及以下教育程度、肿瘤分级WHO Ⅲ-Ⅳ级、次全切除/部分切除、接受术后化疗以及术后出现神经系统症状的中青年胶质瘤患者，其FCRI-SF得分更高，差异具有统计学意义(P＜0.05)。Pearson相关分析结果显示，中青年胶质瘤患者MDASI得分与GAS得分、MCQ-30得分及FCRI-SF得分均呈正相关(均P＜0.05)。而症状困扰、社会疏离以及元认知均能正向预测FCR(P＜0.05)。中介效应分析结果显示，社会疏离与元认知是中青年胶质瘤患者症状困扰与FCR之间的中介变量，总中介效应为0.124(95%CI 0.083～0.165)，占总效应的49.40%。结论：中青年胶质瘤患者存在较高水平的FCR，症状困扰与FCR水平显著相关，且社会疏离与元认知在二者间起到了链式中介作用。

Objective: To explore the chain mediating effects of social alienation and metacognition between symptom distress and fear of cancer recurrence(FCR) in young and middle-aged glioma patients, providing a theoretical basis for psychological intervention strategies. Methods: A cross-sectional study design was adopted, enrolling young and middle-aged glioma patients who underwent surgical treatment in the Department of Neurosurgery of our hospital from April 2022 to October 2024. Questionnaire surveys were conducted using the General Information Questionnaire, M.D. Anderson Symptom Inventory(MDASI),General Alienation Scale(GAS), Metacognitions Questionnaire-30(MCQ-30), and Fear of Cancer Recurrence Inventory-Short Form(FCRI-SF). Univariate analysis was performed to screen potential risk factors for FCR in young and middle-aged glioma patients. Pearson correlation analysis was used to examine the associations between variables. Chain mediating effects were analyzed using the PROCESS plug-in(Model 6). Results: The FCRI-SF score was 14.97±4.84 among participants, with 64.74% ≥13 points. Univariate analysis identified statistically significant predictors of elevated FCR(P<0.05), including younger age(≤40 years), lower educational attainment(junior high school or below), higher tumor grade(WHO Ⅲ-Ⅳ), incomplete surgical resection(subtotal or partial), postoperative chemotherapy administration, and presence of postoperative neurological symptoms. Pearson correlation coefficients demonstrated significant positive relationships of MDASI score with GAS score, MCQ-30 score and FCRI-SF score(P<0.05). Multiple regression analysis further confirmed that symptom distress, social alienation, and metacognition could positively predict FCR(P<0.05). The mediation analysis revealed that social alienation and metacognition were mediating variables of the relationship between symptom distress and FCR. The total indirect effect through this pathway was 0.124(95% CI 0.083-0.165), accounting for 49.40% of the total effect of symptom distress on FCR. Conclusion: Young and middle-aged glioma patients demonstrate clinically significant levels of FCR. Symptom distress is significantly associated with the level of FCR, social alienation and metacognition play a chain-mediating role between them.

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