
闵文宇 ; 石 威
华中科技大学同济医学院附属协和医院,湖北 武汉 430022
摘要:造血干细胞移植(HSCT)是治疗血液系统疾病的有效手段,但移植后抑郁作为长期心理并发症之一,严重影响患者生存质量与预后。研究表明,HSCT后抑郁发生率在不同研究中也所不同,且多在移植后1个月内达症状峰值。危险因素包括:女性、年龄(<60岁)、急性白血病患者、存在慢性移植物抗宿主病或免疫抑制剂使用、炎症因子(如IL-6)、社会支持不足、身体形象不满意、移植前心理状态及疾病感知等。在评估方面,现有研究多应用贝克抑郁问卷、医院焦虑抑郁量表、患者健康问卷等诊断标准。干预措施涵盖非药物干预、心理学干预、社会支持、生物医学干预等。但目前存在干预可行性有限、长期随访数据缺乏等问题,未来研究可完善长期随访数据,也可开发预测模型,实现早期筛查与个性化干预。
关键词:造血干细胞移植;抑郁;影响因素;诊断评估;干预策略
参考文献:
[1]Loberiza FR Jr, Rizzo JD, Bredeson CN, Antin JH, Horowitz MM, Weeks JC, Lee SJ. Association of depressive syndrome and early deaths among patients after stem-cell transplantation for malignant diseases. J Clin Oncol. 2002 Apr 15;20(8):2118-26.
[2]Vaezi M, Gharib C, Souri M, Ghavamzadeh A. Late Complications in acute Leukemia patients following HSCT: A single center experience. Int J Hematol Oncol Stem Cell Res. 2016 Jan 1;10(1):1-6.
[3]Janicsák H, Ungvari GS, Gazdag G. Psychosocial aspects of hematopoietic stem cell transplantation. World J Transplant. 2021 Jul 18;11(7):263-276.
[4]Seo HJ, Baek YG, Cho BS, Kim TS, Um YH, Chae JH. Anxiety and Depression of the Patients with Hematological Malignancies during Hospitalization for Hematopoietic Stem Cell Transplantation. Psychiatry Investig. 2019 Oct;16(10):751-758.
[5]Newcomb R, Johnson PC, Cronin K, Choe JJ, Holmbeck K, Nabily A, Lark P, Rabideau DJ, DeFilipp Z, Chen YB, El-Jawahri A. Quality of Life, Physical Functioning, and Psychological Distress of Older Adults Undergoing Hematopoietic Stem Cell Transplantation. Transplant Cell Ther. 2023 Jun;29(6):387.e1-387.e7.
[6]Wang YM, Huber JF, Flesch L, Demmel K, Lane A, Beebe DW, Crosby LE, Hogenesch JB, Smith DF, Davies SM, Dandoy CE. Trajectory of Sleep, Depression, and Quality of Life in Pediatric HSCT Recipients. Transplant Cell Ther. 2024 Jun;30(6):632.e1-632.e5.
[7]Jeon MJ, Noh E, Moon SJ, Yu ES, Choi CW, Kim DS, Kang EJ. Long-term Psychiatric and Endocrine Complications Following Hematopoietic Stem Cell Transplantation in Hematologic Disease in Korea: A Nation-Wide Cohort Study. Cancer Res Treat. 2024 Oct;56(4):1262-1269.
[8]Cheon J, Lee YJ, Jo JC, Kweon K, Koh S, Min YJ, Park SH, Lee SH, Kim HJ, Choi Y. Late complications and quality of life assessment for survivors receiving allogeneic hematopoietic stem cell transplantation. Support Care Cancer. 2021 Feb;29(2):975-986.
[9]Newcomb R, Johnson PC, Cronin K, Choe JJ, Holmbeck K, Nabily A, Lark P, Rabideau DJ, DeFilipp Z, Chen YB, El-Jawahri A. Quality of Life, Physical Functioning, and Psychological Distress of Older Adults Undergoing Hematopoietic Stem Cell Transplantation. Transplant Cell Ther. 2023 Jun;29(6):387.e1-387.e7.
[10]Turlinskienė M, Seniūnaitė-Ramanauskienė R, Pociūnaitė J, Sargautytė R. Psychological empowerment and quality of life in haematopoietic stem cell transplantation patients: A quantitative study. Nurs Open. 2023 Dec;10(12):7611-7621.
[11]Ames SC, Lange L, Ames GE, Heckman MG, White LJ, Roy V, Foran JM. A prospective study of the relationship between illness perception, depression, anxiety, and quality of life in hematopoietic stem cell transplant patients. Cancer Med. 2024 Feb;13(3):e6906.
[12]Almutairi H, Aboshaiqah A, Alzahrani M, Almutairi AF, Salam M. The Lived Experience of Adult Cancer Survivors After Hematopoietic Stem Cell Transplantation: A Qualitative Study From Saudi Arabia. Patient Prefer Adherence. 2025 Jan 31;19:279-293.
[13]Ward J, Smith J, Powers K, Hellsten M, Murray P. Parent Psychological Distress Is Associated with Symptom Burden and Health-Related Quality of Life in Children and Adolescents Undergoing Stem Cell Transplantation or Chimeric Antigen Receptor T Cell Therapy. Transplant Cell Ther. 2023 Jul;29(7):462.e1-462.e9.
[14]Amonoo HL, Johnson PC, Dhawale TM, Traeger L, Rice J, Lavoie MW, Ufere NN, Longley RM, Harnedy LE, Clay MA, Topping CEW, DeFilipp Z, Chen YA, El-Jawahri A. Sharing and caring: The impact of social support on quality of life and health outcomes in hematopoietic stem cell transplantation. Cancer. 2021 Apr 15;127(8):1260-1265.
[15]Gruber U, Fegg M, Buchmann M, Kolb HJ, Hiddemann W. The long-term psychosocial effects of haematopoetic stem cell transplantation. Eur J Cancer Care (Engl). 2003 Sep;12(3):249-56. PMID: 12919304.
[16]Kirsch JL, Ehlers SL. Factor Analysis of the Beck Depression Inventory-II and Long-Term Hematopoietic Stem Cell Transplantation Survival Using the Research Domain Criteria Framework. Transplant Cell Ther. 2023 Mar;29(3):205.e1-205.e7.
[17]Yanling S, Pu Y, Duorong X, Zhiyong Z, Ting X, Wenjun X, Xiangzhong Z, Jingwen Z. Psychological states and needs among post-allogeneic hematopoietic stem cell transplantation survivors. Cancer Med. 2023 Aug;12(15):16637-16648.
[18]Lee Y, Kim I, Koh Y, Shin D, Hong J, Lee CW, Seo KS. The immediate impact of physical function and quality of life after hematopoietic stem cell transplantation. Support Care Cancer. 2022 Sep;30(9):7439-7446.
[19]Akaho R, Otsu A, Igarashi A, Aoki Y, Takemura T, Kobayashi S, Ohashi K, Nishimura K. No Evidence for Particular Association Between HLA-Haploidentical Hematopoietic Stem Cell Transplantation and Psychological Distress. Transplant Proc. 2019 Jul-Aug;51(6):1990-1993.
[20]Mosher CE, DuHamel KN, Rini C, Corner G, Lam J, Redd WH. Quality of life concerns and depression among hematopoietic stem cell transplant survivors. Support Care Cancer. 2011 Sep;19(9):1357-65.
[21]Rømer TB, Sengeløv H, Christensen RHB, Benros ME. Associations Between Mental Disorders in Donors and Matched Recipients of Hematopoietic Stem Cell Transplants: A Population-Based Cohort Study. Biol Psychiatry Glob Open Sci. 2024 Aug 26;4(6):100389.
[22]Tavakoli-Ardakani M, Mehrpooya M, Mehdizadeh M, Hajifathali A, Abdolahi A. Association between Interlukin-6 (IL-6), Interlukin-10 (IL-10) and depression in patients undergoing Hematopoietic stem cell transplantation. Int J Hematol Oncol Stem Cell Res. 2015 Apr 1;9(2):80-7. PMID: 25922648; PMCID: PMC4410293.
[23]Kang D, Kim IR, Choi HJ, Jung CW, Yoon SS, Kim JS, Lee CH, Jang JH, Cho J. Association between body image dissatisfaction and poor quality of life and depression among patients with hematopoietic stem cell transplantation. Support Care Cancer. 2021 Jul;29(7):3815-3822.
[24]Dóro CA, Neto JZ, Cunha R, Dóro MP. Music therapy improves the mood of patients undergoing hematopoietic stem cells transplantation (controlled randomized study). Support Care Cancer. 2017 Mar;25(3):1013-1018.
[25]Xie J, Wan Z, Duan Y, Wang M, Luo Y, Xiao P, Kang Y, Zhou Y, Luo X, Sun Q, Cheng ASK. The efficacy of live music for adolescent and young adult patients during hematopoietic stem cell transplantation. Support Care Cancer. 2022 Jul;30(7):5789-5799.
[26]Yildiz Kabak V, Cetinkaya DU, Kuskonmaz B, Cetin N, Duger T. Effects of multimodal exercise on clinical status and patient-reported outcomes in children undergoing hematopoietic stem cell transplantation. Pediatr Hematol Oncol. 2019 Oct;36(7):410-421.
[27]Balck F, Zschieschang A, Zimmermann A, Ordemann R. A randomized controlled trial of problem-solving training (PST) for hematopoietic stem cell transplant (HSCT) patients: Effects on anxiety, depression, distress, coping and pain. J Psychosoc Oncol. 2019 Sep-Oct;37(5):541-556.
[28]Grossman P, Zwahlen D, Halter JP, Passweg JR, Steiner C, Kiss A. A mindfulness-based program for improving quality of life among hematopoietic stem cell transplantation survivors: feasibility and preliminary findings. Support Care Cancer. 2015 Apr;23(4):1105-12.
[29]Cioce M, Borrelli I, Cappucciati L, Giori M, Gobbi G, Lucifora R, Mabilia P, Marsullo M, Prendin C, Russo L, Zucca MS, Zega M, Sica S, Bacigalupo A, De Stefano V, Savoia V, Celli D, Garau P, Serra N, Botti S. The impact of education on patients' psycho-emotional status during allogeneic hematopoietic stem cell transplantation: a multicenter prospective study by thes Gruppo Italiano Trapianto di Midollo Osseo. J Psychosoc Oncol. 2023;41(6):687-703.
[30]Tavakoli-Ardakani M, Kheshti R, Maryam M. Effect of sertraline on complications and survival after hematopoietic stem-cell transplantation, a double-blind, placebo-controlled clinical study. Int J Hematol. 2017 Dec;106(6):832-841.
[31]Imamura T, Sudo T, Orihashi Y, Takahashi Y, Onishi Y, Onizuka M, Mikami K, Ueda Y, Yamamoto K. Psychosocial factors predicting symptoms of depression and anxiety in allogeneic hematopoietic stem cell transplant recipients in Japan. Int J Psychiatry Med. 2024 May;59(3):287-302.