目的分析自体外周血造血干细胞移植(ASCT)联合大剂量化疗(HDCT)的高危乳腺癌患者在移植前后生活质量的变化情况,以期为医务工作者选择有针对性和有效性的干预措施改善患者的生活质量提供参考。方法选取2000～2003年本院经手术病理确诊并接受ASCT联合HDCT的61例女性高危乳腺癌患者,中位年龄46岁,作为病例组;用随机数字表法在320个普通健康人群中选取50例35～65岁健康女性作为对照组。采用欧洲癌症研究与治疗组织生活质量问卷第三版(EORTC QLQ-C30 version 3.0)作为问卷调查表。病例组选取5个时间点在患者返院复查时填写调查表,对照组经得同意后填写调查表,根据各个条目得分情况进行分析。采用重复测量法和两独立样本t检验进行统计分析。结果总体上患者在ASCT结束后3个月生活质量最差,此后逐渐恢复接近健康人水平,但很多方面仍与健康人相比存在明显差别。躯体功能在ASCT前后无显著性差别,但ASCT后5年的患者与对照组之间差异有统计学意义(P=0.000)。患者的情绪功能在ASCT后3个月时较ASCT前明显降低(P=0.000),虽然ASCT后3年较ASCT前显著升高(P=0.000),但ASCT后5年与健康对照组比较差异有统计学意义(P=0.011)。患者疲劳症状在ASCT后3个月比ASCT前显著增加(P=0.000),而随着时间推移有所缓解,ASCT后5年此症状才出现明显减轻,但较健康对照组差异有统计学意义(P=0.031)。病例组患者恶心呕吐症状在ASCT后3个月最明显,此后逐渐缓解,ASCT后3年明显改观,ASCT后5年与健康对照组相比差异无统计学意义(P=0.474)。病例组患者疼痛症状在ASCT前后一直存在,ASCT后5年与健康对照组比较差异有统计学意义(P=0.014)。病例组患者经济困难在ASCT前与ASCT后3个月间差异有显著的统计学意义(P=0.000),ASCT后5年有所缓解,但与健康对照组相比仍存在较为严重的经济问题(P=0.005)。结论 ASCT后患者普遍存在躯体功能受损、记忆力减退、社会家庭功能退缩、精神紧张、易疲劳、疼痛、经济困难等生活质量下降的情况,大部分可在移植后5年恢复到健康人水平,而躯体功能、疼痛症状、经济等方面仍存在严重问题。医护人员及患者家人应当给予精心护和理解照顾,帮助患者尽快改善生活质量、恢复正常生活。 Objective To analyze the changes of quality of life before and after transplantation of high-risk breast cancer patients with autologous peripheral blood hematopoietic stem cell transplantation (ASCT) and high-dose chemotherapy (HDCT) in order to select the targeted and effective interventions for medical workers to improve the patients’ Quality of life for reference. Methods A total of 61 high-risk breast cancer patients diagnosed as ASCT combined with HDCT from 2000 to 2003 in our hospital were selected. The median age was 46 years old. The patients were selected as the case group by random number table method. Among the 320 normal healthy subjects, Cases of healthy women aged 35 to 65 years as a control group. The European Organization for Research and Treatment of Cancer in Europe (EORTC QLQ-C30 version 3.0) was used as a questionnaire. The case group selected 5 time points in the review of patients returned to fill in the questionnaire, the control group after obtaining consent to fill in the questionnaire, according to the score of each entry analysis. Repeated measures and two independent samples t-test for statistical analysis. Results Overall, patients had the poorest quality of life 3 months after the end of ASCT, and then returned to healthy levels gradually, but in many aspects, there were still significant differences compared with healthy people. There was no significant difference in somatic function before and after ASCT, but there was a significant difference between the 5-year ASCT patients and the control group (P = 0.000). The emotional function of patients at 3 months after ASCT was significantly lower than that before ASCT (P = 0.000). Although the 3-year ASCT was significantly higher than that before ASCT (P = 0.000), the difference between 5-year ASCT and healthy controls was significant There was statistical significance (P = 0.011). The symptom of fatigue in patients was significantly increased 3 months after ASCT compared with that before ASCT (P = 0.000), but with the alleviation of time, this symptom was relieved 5 years after ASCT, but the difference was statistically significant compared with healthy control group (P = 0.031). The symptoms of nausea and vomit in case group were the most obvious at 3 months after ASCT, and then gradually relieved. After 3 years of ASCT, the symptoms of nausea and vomit changed obviously. There was no significant difference between the 5 years after ASCT and the healthy control group (P = 0.474). The pain symptom of patients in the case group existed before and after ASCT, and the difference was statistically significant at 5 years after ASCT compared with the healthy control group (P = 0.014). The economic difficulties of patients in the case group were significantly different between pre-ASCT and post-ASCT 3 months (P = 0.000), and were relieved 5 years after ASCT. However, there were still serious economic problems compared with the healthy control group (P = 0.005). CONCLUSION: After ASCT, the quality of life of the patients with impaired somatic function, memory loss, withdrawal of social family function, mental stress, fatigue, pain and financial difficulties are all common in ASCT patients. Most of them may recover to healthy level 5 years after transplantation, However, there are still serious problems in body function, pain symptoms and economy. Caregivers and family members should give careful care and understanding to help patients improve their quality of life and resume normal life as soon as possible.