Analysis of the latent profile and transition of self-disgust in patients with colorectal cancer before and after stoma surgery
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摘要:
目的 探索结直肠癌患者造口手术前后自我厌恶潜在类别随时间变化趋势并分析其影响因素。 方法 采用便利抽样法选取温州医科大学附属第二医院于2023年2月—2025年2月收治的结直肠癌患者作为调查对象，采用一般资料调查表、自我厌恶量表对入组的调研对象在入院时（T1）、出院前（T2）进行测量进行潜在转变分析。 结果 202例患者完成调查。造口手术前后可分为高自我厌恶组、低自我厌恶组2个潜在类别。高自我厌恶组稳定性强，保持原组的概率为0.856，低自我厌恶组结直肠癌患者随时间发展倾向于向高自我厌恶组转变，转变概率为0.272。Logistic回归分析结果显示，自评心理失衡（OR=4.722）、自评社会低支持（OR=3.380）的患者由低自我厌恶组转变为高自我厌恶组的概率增加（OR＞1），而家庭月收入＞10 000元（OR=0.725）的患者由低自我厌恶组转变为高自我厌恶组的概率降低（OR＜1）。≥60岁（OR=1.256）、家庭居住（OR=1.347）、自评心理健康（OR=2.422）、自评高支持（OR=3.279）的患者由高自我厌恶组转变为低自我厌恶组的概率升高（OR＞1）。 结论 结直肠癌患者造口手术前后的自我厌恶状态存在显著的异质性，主要分为高、低2个亚组。低自我厌恶组在围手术期具有较高的恶化风险，且受心理失衡及社会支持不足的驱动；而高龄、家庭居住及良好的心理状态是促进高自我厌恶患者向良性转归的保护因素。 Abstract:Objective To explore the changing trend of potential categories of self-disgust in patients with colorectal cancer before and after stoma surgery over time and analyze its influencing factors. Methods Colorectal cancer patients admitted to the Second Affiliated Hospital of Wenzhou Medical University from February 2023 to February 2025 were selected as the research objects by convenience sampling method. The general information questionnaire and self-disgust scale were used to measure the enrolled research objects at admission (T1) and before discharge (T2) for potential transformation analysis. Results A total of 202 patients completed the investigation. Before and after stoma surgery, patients can be divided into two potential categories: the high self-disgust group and the low self-disgust group. The stability of the high self-disgust group was strong, and the probability of maintaining the original group was 0.856. Colorectal cancer patients in the low self-disgust group tended to transform to the high self-disgust group over time, and the transformation probability was 27.20%. The results of logistic regression analysis show that: patients who self-rated psychological imbalance (OR=4.722) and self-rated low social support (OR=3.380) had an increased probability of changing from the low self-disgust group to the high self-disgust group (OR>1), while patients with a monthly family income>10 000 yuan (OR=0.725) had a decreased probability of changing from the low self-disgust group to the high self-disgust group (OR < 1). Patients aged ≥60 years old (OR=1.256), residing at home (OR=1.347), self-rated mental health (OR= 2.422), and self-rated high support (OR=3.279) had an increased probability of changing from the high self-disgust group to the low self-disgust group (OR>1). Conclusion There is significant heterogeneity in the self-abusive state of colorectal cancer patients before and after ostomy surgery, mainly divided into two subgroups: high and low. The study confirmed that the low self-abusive group has a higher risk of deterioration during the perioperative period, driven by psychological imbalance and insufficient social support; while advanced age, family residence, and good psychological state are protective factors for promoting a favorable outcome in patients with high self-abusive status. -
表 1 不同潜在剖面模型拟合参数指标比较
Table 1. Comparison of fitting parameter indicators for different potential profile models
时间 模型 AIC BIC aBIC Entropy LRT BLRT 类别概率 T1 1 1 929.921 1 946.673 1 921.511 2 1 891.754 1 898.985 1 878.094 0.824 0.013 ＜0.001 0.57/0.43 3 1 876.102 1 863.799 1 857.187 0.877 0.094 ＜0.001 0.24/0.48/0.28 4 1 752.043 1 780.211 1 722.875 0.901 0.234 0.142 0.25/0.10/0.21/0.44 T2 1 1 943.256 1 999.227 1 937.838 2 1 817.912 1 818.264 1 823.914 0.912 0.000 ＜0.001 0.45/0.55 3 1 716.988 1 758.720 1 728.831 0.924 0.071 ＜0.001 0.27/0.48/0.25 4 1 611.536 1 681.824 1 624.849 0.935 0.140 ＜0.001 0.25/0.19/0.23/0.33 
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表 2 结直肠癌患者造口手术前后自我厌恶的潜在状态概率和潜在转变概率
Table 2. Probability of potential states and potential transitions of self-loathing in patients with colorectal cancer before and after ostomy surgery
项目 时间点 低自我厌恶组 高自我厌恶组 潜在状态概率 T1 0.866 0.134 T2 0.585 0.415 手术前后的潜在转变概率 低自我厌恶组 0.728 0.272 高自我厌恶组 0.144 0.856
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表 3 结直肠癌患者造口手术前后自我厌恶潜在类别的单因素分析(例)
Table 3. Univariate analysis of potential categories of self-loathing in patients with colorectal cancer before and after ostomy surgery (cases)
变量 手术前 统计量 P值 手术后 统计量 P值 低自我厌恶组(n=115) 高自我厌恶组(n=87) 低自我厌恶组(n=91) 高自我厌恶组(n=111) 年龄(岁) 4.817a 0.028 9.986a 0.002 ＜60 43 46 29 60 ≥60 72 41 62 51 婚姻状况 0.823a 0.663 1.837a 0.399 未婚 3 4 2 5 已婚 107 78 86 99 离婚 5 5 3 7 学历 0.983b 0.326 0.001b 0.999 小学及以下 48 33 35 46 初中 55 39 46 48 高中及以上 12 15 10 17 居住地 3.122a 0.077 1.768a 0.184 城镇 49 48 39 58 农村 66 39 52 53 家庭人均月收入(元) 2.067b 0.039 3.379b 0.001 ＜4 000 22 23 15 30 4 000~6 999 40 38 30 48 7 000~10 000 40 18 29 29 ＞10 000 13 8 17 4 居住方式 0.250a 0.617 4.152a 0.042 独居 6 6 2 10 家庭居住 109 81 89 101 共病数量(个) 2.505a 0.114 3.291a 0.070 ＜3 81 52 66 67 ≥3 34 35 25 44 自评心理状况 4.335b ＜0.001 3.579b ＜0.001 健康 45 11 36 20 亚健康 62 61 49 74 失衡 8 15 6 17 自评社会支持 2.625b 0.009 5.794b ＜0.001 低支持 19 26 9 36 中支持 64 47 45 66 高支持 32 14 37 9 注：a为χ2值，b为Z值；自评心理健康和自评社会支持均采用温州医科大学附属第二医院入院护理评估单，均在入院后6 h评估完毕。
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表 4 结直肠癌患者造口手术前后自我厌恶的潜在转变的影响因素转变概率发生比
Table 4. Factors influencing the potential transformation of self-aversion in patients with colorectal cancer before and after ostomy surgery transformation probability incidence ratio
变量 类别 潜在状态术前→术后 OR值 P值 低自我厌恶组 高自我厌恶组 年龄 ≥60岁 低自我厌恶组 - 1.305 0.102 高自我厌恶组 1.256 - 0.012 家庭月收入(元) 4 000~6 999 低自我厌恶组 - 1.027 0.233 高自我厌恶组 0.689 - 0.156 7 000~10 000 低自我厌恶组 - 1.240 0.304 高自我厌恶组 0.532 - 0.211 ＞10 000 低自我厌恶组 - 0.725 0.005 高自我厌恶组 0.485 - 0.072 居住方式 家庭居住 低自我厌恶组 - 0.826 0.103 高自我厌恶组 1.347 - 0.010 自评心理状况 健康 低自我厌恶组 - 0.826 0.158 高自我厌恶组 2.422 - 0.003 失衡 低自我厌恶组 - 4.722 ＜0.001 高自我厌恶组 0.457 - 0.235 自评社会支持 高支持 低自我厌恶组 - 0.922 0.560 高自我厌恶组 3.279 - 0.004 低支持 低自我厌恶组 - 3.380 ＜0.001 高自我厌恶组 0.752 - 0.414 注：变量赋值如下，年龄(＜60岁=0，≥60岁=1)；家庭月收入(＜4 000元=0，4 000~6 999元=1，7 000~10 000元=2，＞10 000元=3)；居住方式(独居=0，家庭居住=1)；自评心理状况(亚健康=0，健康=1，失衡=2)；自评社会支持(中支持=0，高支持=1，低支持=2)。"-"表示以该组为参照，无OR值。
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