基于主成分分析法探讨肝细胞癌症状对患者健康相关生活质量的影响-东南大学学报医学版

基于主成分分析法探讨肝细胞癌症状对患者健康相关生活质量的影响

单位：南京医科大学第一附属医院感染病科, 江苏南京 210000

分类号：R735.7

出版年·卷·期（页码）：2026·45·第二期（266-274）

摘要：

目的:探讨保守治疗期肝细胞癌患者的症状特征及其对生活质量结局的影响。方法:回顾性收集2024年1月至2025年4月在我院治疗的原发性肝细胞癌患者的临床资料,根据生活质量测定量表简表评分将患者判定为低生活质量组和高生活质量组。采用1:1倾向性匹配法,以年龄、性别、病程、TMN分期、Child分期、肝外转移、乙肝病史、丙肝病史、肝硬化病史和手术史、治疗方法等临床因素为协变量,进行匹配。采用安德森症状评估量表和原发性肝细胞癌特异性症状模块评估患者的一般性癌症症状和肝细胞癌特异性症状的发生率和严重程度。采用主成分分析(principal component analysis,PCA),基于特征值＞1,提取患者生活质量结局的主成分;采用最大正交旋转法,确定主成分的载荷系数构造,识别影响生活质量结局的重要症状因素。结果:PCA分析显示,肝细胞癌症状可以聚集成群。疲乏(载荷系数=0.986)、睡眠障碍(载荷系数=0.967)、疼痛(载荷系数=0.964)和恶心(载荷系数=0.915)等一般症状是第一成分的主要载荷因子;腹胀(载荷系数=0.968)、腹泻(载荷系数=0.842)和皮肤黄染(载荷系数=0.936)等特异性症状是第二和第四主成分的主要载荷因子;解释了肝细胞癌症状的86.7%的特征,构成影响生活质量结局的重要因素。结论: 肝细胞癌患者症状负担较重,严重影响生活质量,其中疲乏、睡眠障碍、疼痛、恶心、腹胀、腹泻和皮肤黄染是造成患者生存质量低下的重要症状因素。临床应采取针对性管理措施和优先干预,以改善肝细胞癌患者的生活质量。

Objective: To investigate the clinical symptoms and their association with health-related quality of life(HR-QoL) in hepatocellular carcinoma(HCC) patients during conservative treatment. Methods: Clinical data of patients with HCC treated at our hospital from January 2024 to April 2025 was collectted retrospectively. Patients were stratified into high-QoL(≥40) and low-QoL(＜40) groups by WHOQOL-BREF scores. Propensity score matching was performed in a 1:1 ratio using baseline covariates. Symptom burden was assessed via the Symptom Module specific to Primary Liver Cancer and Anderson Symptom Assessment Scale. Principal component analysis(PCA) was used to identify primary risk factors for HR-QoL. Results: PCA analysis revealed that general symptoms like fatigue(loading=0.986), sleep disturbances(loading=0.967), pain(loading=0.964) and nausea(loading=0.915) were the primary contributors to the first component. Specific symptoms such as abdominal bloating(loading=0.968), diarrhea(loading=0.842) and skin jaundice(loading=0.936) were the main contributors to the second and fourth principal components. These factors accounted for 86.7% of the symptoms characteristics, playing a significant role in HR-QoL. Conclusion: Clinical symptoms in HCC exhibit high burden. Prioritized management of the above-mentioned symptoms might significantly improve HR-QoL.

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