癌末病患疲倦感與細胞激素相關因素之探討

Fatigue and Cytokines in Terminal Cancer Patients

蔡宜娟(Yi-Chuan Tsai)

指導教授 ： 吳麗珍

共同指導教授 ： 何聖佑

長榮大學/健康科學學院/護理學研究所/碩士(2007年)

https://doi.org/10.6833/CJCU.2007.00075

摘要

台灣從1982年起，惡性腫瘤已連續二十五年蟬聯死因首位。幾乎所有的癌症病患都有過某種程度的疲倦，而高達90%的癌症末期病患正在經歷疲倦感。因此，疲倦是癌症最常見的症狀困擾之一，也嚴重的衝擊到病患的生活品質。有研究指出，癌症病患的細胞激素濃度有上升的現象，也發現疲倦與腫瘤進展的細胞激素有關。本前瞻性縱貫研究目的為測量癌末病患之疲倦感與細胞激素濃度間之相關性。以台灣南部某地區教學醫院安寧病房之住院癌末病患為對象。納入收案的條件為年滿20歲，經確立診斷為癌症末期病患，意識清楚、可由語言溝通，並簽署同意書者。病患入院三天內收案為第一天，有42人參與此研究，以問卷與血液收集每週一次，第八天有21人及第十五天有12人。血液檢體測量WBC, Hb, platelet, CRP, BUN, creatinine, GOT, GPT, albumin, pre-albumin與細胞激素（TNF-α, IL-10）的濃度。而細胞激素濃度的測定以ELISA（enzyme-link immunosorbent assay）技術來操作。疲倦程度問卷包含三部分，量測病患主觀的感受，分別為疲倦視覺量表（FVAS）、症狀困擾量表（SDS）及病歷資料。統計分析採用皮爾森相關係數（Pearson’s product moment correlation coefficient）與重複測量（ANOVA-Repeated measurements）方式進行。結果顯示，疲倦之嚴重程度隨住院時間有增加的趨勢，而疲倦困擾程度接近中度困擾，但在三階段住院期間的變化均相同。疲倦嚴重程度與症狀困擾（r = 0.38，p<0.05）及身體活動功能分數（r = 0.33，p<0.05）皆有正相關；症狀困擾總分（F = 4.29，p<0.05）與失眠（F = 5.79，p<0.05）與便秘（F = 3.45，p<0.05）在住院期間困擾皆有改善；疲倦與噁心嘔吐（r = 0.35，p<0.05）、食慾差（r = 0.32，p<0.05）、失眠（r = 0.48，p<0.01）、便秘（r = 0.48，p<0.01）、專注力差（r = 0.54，p<0.01）均有正相關。疲倦嚴重程度與所有血液檢驗值均無相關，疲倦困擾程度與Hb（r = 0.45，p<0.05）、WBC（r = 0.63，p<0.05）有正相關。細胞激素（TNF-α，IL-10）與疲倦嚴重程度無關；但TNF-α及IL-10在第一天（r = 0.68，p<0.001）與第八天 （r=0.64，p<0.001）都互相有高度相關；而控制症狀群困擾分數與Hb兩因子後，疲倦嚴重程度與TNF-α（r = 0.45，p<0.01）有相關，但與IL-10（r = 0.28，p = 0.12）無相關。由本研究發現，疲倦在癌末病患住院過程中，是最常見的症狀，但仍無良好的指標來測量疲倦。細胞激素與疲倦程度無顯著相關性。而症狀困擾及身體功能分數與疲倦程度有正相關。瞭解疲倦之生理現象將有助於我們發展護理措施與診斷的參考。

關鍵字

疲倦 ； 細胞激素 ； 癌症末期 ； 症狀群 ； 疲倦困擾

並列摘要

Since 1982, malignant tumors have been the leading cause of death in Taiwan. Almost all patients of cancer complain of various degrees of fatigue and more than 90% suffer from fatigue in the terminal stage. Studies have shown that fatigue is related to cytokines in tumor progression, and elevated levels of several cytokines have been found in cancer patients. The purpose of this longitudinal study is to examine the correlation between fatigue and plasma cytokine levels in terminal cancer patients. The investigator recruited 42 patients from a palliative care unit at a local hospital in southern Taiwan. Terminal cancer patients that were 20 years-old and older were included in this study, and those who could not communicate were excluded. Blood samples were collected on day 1 （after being admitted）, day 8, and day 15. Fatigue severity questionnaires were administered as well. The blood samples were measured for WBC, Hb, platelet, CRP, BUN, creatinine, GOT, GPT, albumin, pre-albumin, and cytokines （TNF-α, interleukin-10）. The cytokine levels in the blood were measured by using enzyme-link immunosorbent assay （ELISA）. Two inventories were used in this study to investigate subjective fatigue syndrome: the Fatigue Visual Analogue Scale and Symptom Distress Scale. Pearson’s product moment correlation coefficient and ANOVA repeated measurements were used for data analysis.
This study showed that subjects did suffer from moderate degrees of fatigue and their suffering slightly increased during the data collecting period. However, the changes were not significant. Fatigue severity was correlated to symptom distress （rd1=0.38, p<0.05） and activity performance status （rd1=0.33, p<0.05）. Fatigue is related to other symptoms such as nausea （r=0.35, p<0.05）, poor appetite （r=0.32, p<0.05）, insomnia （r=0.48, p<0.01）, constipation （r=0.48, p<0.01）, and concentration difficulty （r=0.54, p<0.01）. The symptom control during hospitalization was noted, including total symptom distress （F=4.289, p<0.05）, insomnia （F=5.79, p<0.05）, and constipation （F=3.45, p<0.05）. Fatigue severity was not related to all of the serum lab parameters. The fatigue distress levels were associated with Hb （r=0.45, p<0.05） and WBC （r=0.63, p<0.05）. With regard to cytokines, TNF-α and IL-10 are highly correlated for both day 1 （rd1=0.68, p<0.001） and day 8 （rd8=0.64, p<0.001）；no relationship was found between fatigue severity and cytokines（TNF-α, IL-10）. However when controlling SDS total score and Hb, fatigue severity was correlated to TNF-α （rd1=0.45, p<0.01）.
The research results showed that fatigue is one of the most common symptoms that terminal cancer patients have and their fatigue continues during hospitalization although other symptoms have been reduced. Since TNF-α and IL-10 were not correlated to severity of fatigue, the patients’s subjective feeling is the most important indicator of fatigue. Thus, the health care providers should listen to patients’ complaints carefully in order to find interventions to assist patients in reducing their suffering from fatigue.

並列關鍵字

fatigue, cytokines ； terminal cancer ； symptom cluster ； fatigue distress

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