健康与遗传心理学研究室知识库

本论文将乳腺癌患者与非癌症患者比较，分析乳腺癌患者的人格特点，及各诊治阶段的情绪适应和心境特点;分析不同人格倾向的乳腺癌患者各诊治阶段情绪适应和心境的差异，探讨人格倾向和诊治处理对患者情绪适应、心境的影响;分析不同人格倾向的乳腺癌患者预后相关生理指标的差异，初步探讨患者人格倾向与预后的关系机制。论文研究以艾森克人格问卷(the Eysenck Personality Questionnair, EPQ)先后测查了83名乳腺癌患者和109名乳腺良性疾病患者的人格倾向;并分别在诊断前后、手术前后、化疗前后以癌症病人情绪适应问卷(the Mental Adjustment to Cancer Scall, MAC)、简明心境问卷(the Breif of前ood States, BPOMS)测查了患者的情绪适应和心境状况。以免疫组化、流式细胞仪免疫荧光检测等方法检测了乳腺癌患者肿瘤组织BRCA 1, P53 ,CerbB2基因表达情况;雌激素受体(ER)、黄体酮受体(PR)表达情况:肿瘤组织分级情况;以及手术前患者的细胞免疫功能，包括:外周血白细胞总数 CWBC), T淋巴细胞亚群(全T淋巴细胞(CD3 )比例、诱导/辅助T淋巴细胞(CD4)比例、细胞毒/抑制T淋巴细胞(CD8 )比例、CD4/CD8值)、以及自然杀伤细胞(NK)活性。结果发现:
1.乳腺癌患者人格内外向分数明显高于乳腺良性疾病患者和健康妇女，说明乳腺癌患者具有外向的人格特点。
2.一定的诊治时期，乳腺癌患者与乳腺良性疾病患者的情绪适应存在差异，表现为:在诊断期，乳腺癌患者的宿命反应分数较乳腺良性疾病患者高。一定的诊治处理对患者的情绪适应和心境存在影响，表现为:化疗前，乳腺癌患者的焦虑和逃避情绪适应分数较手术后高;化疗后，乳腺癌患者的疲乏一无力和情绪扰乱总分较化疗前高。诊断对良恶性患者心境的影响有所不同，表现为:诊断后，乳腺良性疾病患者抑郁一沮丧分数较诊断前降低，而乳腺癌患者较诊断前升高。
3.不同人格倾向的乳腺癌患者情绪适应和心境存在差异，但这种差异仅在相应的诊治时期表现明显，包括:在手术期，高精神质水平的患者宿命情绪适应分数明显高于低精神质水平的患者，低掩饰水平的患者失望情绪适应分数和愤怒一敌意心境分数较高;在化疗期，外向的患者失望情绪适应分数和愤怒一敌意心境分数较低。诊治处理对患者的情绪适应和心境存在影响，且这种影响在一定程度上因患者的人格倾向而异。包括:诊断后，低精神质水平的患者逃避情绪适应分数较诊断前升高，而精神质水平中等或高精神质水平的患者则下降或无变化;手术后，内外向适中的患者紧张一焦虑心境分数较手术前升高，而内向或外向的患者则下降;手术后，患者疲乏一无力心境分数较手术前增加;化疗后，患者的疲乏一无力和情绪扰乱总分均较化疗前增加，并且，化疗后，仅低精神质水平和精神质水平中等的患者疲乏一无力心境分数较化疗前升高，而高精神质水平的患者则下降。
4.外向的乳腺癌患者肿瘤组织CerbB2和P53阳性率较高、说明外向的患者由于基因表达方面的生理特点而可能预后较差。精神质水平高的乳腺癌患者BRCA 1阳性率较高，提示精神质水平高的患者乳腺癌发生与BRCAI基因的变异有更大的联系，且患者由于基因表达方面的生理特点而可能预后较差。本论文未发现不同人格倾向的乳腺癌患者细胞免疫功能的差异，但发现愤怒一敌意和情绪扰乱较严重的乳腺癌患者CD8淋巴细胞比例较低，而精力一活力心境分数高的患者NK细胞活性较高，提示愤怒一敌意和情绪扰乱水平较高的患者免疫系统杀伤、抑制肿瘤细胞的能力较低，而精力一活力水平高的患者免疫系统监视、清除肿瘤细胞的能力较强。

Eighty three breast cancer patients and one hundred and nine benign breast disease patients were examined by the Eysenck Personality Questionnaire (EPQ) for their personality in Psychoticism, Extroversion-Introversion, Neuroticism and Lie. These patients were also examined by the Mental Adjustment to Cancer Scale (MAC) for their mental adjustment reaction to the disease in Fighting Spirit, Helplessness/Holplessness, Anxious Preoccupation, Fatalistic and Avoidance, and by the Brief Profile of Mood States (BPOMS) for their mood states in Tension-Anxiety, Anger-Hostility, Vigor-Activity,Depression-Dejection,Fatigue-Inertia, Confusion-Bewilderment, and Total Mood Distress before and after diagnosis and/or before and after operation and/or..before and after chemotherapy. The BRCA1，P53, CerbB2 gene status, estrogen and progesterone receptor status, and histological types of breast lesions of the breast cancer patients were also assessed. The blood samples were taken from breast cancer patients before operation to evaluate their cellular immune function including subsets of lymphocytes, natural killer cell伽K) cytotoxicity. and the number of peripheral white blood cells (WBC). The results obtained were as follows:
1 .The breast cancer patients showed higher scores on Extraversion compared to benign breast disease patients and normal women, and higher scores on Psychoticism compared to the benign breast disease patients only.
2. In diagnosis period (before and after diagnosis) the breast cancer patients showed higher scores in Fatalism than the benign breast disease patients. The scores on Anxious Preoccupation and Avoidance of breast cancer patients before chemotherapy were higher than that of breast cancer after chemotherapy. The after operation.chemotherapy The scores on Fatigue-Inertia were higher than before on Depression-Dejection of breast cancer raised from before to after diagnosis while the scores of benign disease patients patients declined during the same period.
3. In operation period (before and after operation) the breast cancer patients characterized by high Psychoticsm showed higher scores on Fatalistic, the patients characterized by high Lie showed higher scores on Helplessness/Hopelessness as well as Anger-Hostility. In chemotherapy period (before and after chemotherapy) the breast cancer patients characterized by high Extroversion showed lower scores either on Helplessness /Hopelessness or Anger-Hostility. Only the breast cancer patients characterized by high Psychoticism did show that the scores on Aviodant raised form before to after diagnosis while other patients showed the scores declined. The breast cancer patients being normal Extroversion-Introversion showed the scores on Tension-Anxiety raised from before to after operation while the scores of other patients declined. The scores on Fatigue-Inertia of the breast cancer patients raised from before to after operation. The scores on Fatigue-Inertia and Total Mental Distress of the breast cancer patients were raised from before to after chemotherapy. Furthermore, only patients characterized by low or normal Psychoticsm showed these scores increased while those patients characterized by high Psychoticsm showed these scores declined.
4. The expression of CerbB2 and P53 genes was higher in those patients characterized by high Extroversion, while the expression of BRCAI gene was higher in patients characterized by high Psychoticism. No difference in cellular immune function among patients with different characteristics of personality was found. However, there were negative correlations between scores on Anger- Hostility and Total Mood Distress and persontage of CD8 lymphocyte, there was also a positive correlation between scores on Vigor-Activity and NKcytotoxicity.