【摘要】 目的：识别肺癌免疫治疗患者疲乏相关症状群（疲乏-食欲下降-疼痛）的变化轨迹及其影响因素。方法：2022年3月—2023年3月便利选取在复旦大学附属肿瘤医院就诊的114例首次接受免疫治疗的肺癌患者作为研究对象。采用PRO-CTCAE肺癌免疫治疗子集进行为期6个月的纵向随访，同时在首次用药前收集患者的人口学、疾病生理、心理、社会和健康生活方式资料。采用增长混合模型和logistic回归分析，识别患者疲乏相关症状群的轨迹类别及其影响因素。结果：识别出肺癌免疫治疗患者的2条疲乏变化轨迹，命名为“轻中度疲乏持续组”“轻度疲乏产生-缓解组”。识别出食欲下降的3条变化轨迹，命名为“食欲下降加重组”“轻度食欲下降维持组”“食欲下降加重-缓解组”。识别出疼痛的3条变化轨迹，命名为“轻度疼痛缓解组”“轻度疼痛维持组”“轻中度疼痛加重组”。logistic回归分析结果显示，年龄（OR=1.076,P=0.015）和靶向治疗（OR=10.743,P=0.009）是疲乏的影响因素。病程（OR=0.112,P=0.015）、培美曲塞（OR=3.210,P=0.027）和靶向治疗（OR=7.077,P=0.032）是疼痛的影响因素。尚未发现食欲下降的影响因素。结论：肺癌免疫治疗患者疲乏相关症状群的症状变化轨迹存在差异性。少数患者的食欲下降和疼痛呈现持续加重的趋势。未来研究可继续根据症状特征类别分析干预节点，并通过影响因素帮助医护人员识别重点人群，为肺癌免疫治疗患者提供个性化和全程化的症状管理。更多还原

【Abstract】 Objective: To identify the trajectory of fatigue-related symptom clusters(fatigue-decreased appetite-pain) in patients with lung cancer receiving immunotherapy and their influencing factors.Methods: From March 2022 to March 2023, 114 patients with lung cancer receiving immunotherapy for the first time in Fudan University Shanghai Cancer Center were selected as research subjects. A 6-month longitudinal follow-up was performed using the PROCTCAE-based subset for lung cancer immunotherapy, and the demographic, disease physiological, psychological, social and healthy lifestyle data of patients were collected before the first dose. Growth mixed model and logistic regression analysis were used to identify the trajectory categories and influencing factors of fatigue-related symptom clusters.Results: Two fatigue trajectories of patients with lung cancer receiving immunotherapy were identified, named "mild to moderate fatigue persistent group" and "mild fatigue production-relief group". Three trajectories of decreased appetite were identified and named "decreased appetite aggravation group", "mild decreased appetite maintenance group" and "decreased appetite exacerbation-relief group". Three trajectories of pain were identified, named "mild pain relief group", "mild pain maintenance group" and "mild to moderate pain aggravation group". Logistic regression analysis showed that the age(OR=1.076, P=0.015) and targeted therapy(OR=10.743, P=0.009) were influential factors for fatigue. Duration of disease(OR=0.112, P=0.015), pemetrexed(OR=3.210, P=0.027) and targeted therapy(OR=7.077, P=0.032) were influential factors for pain. No influencing factors for decreased appetite have been identified.Conclusion: There is variability in the trajectory of symptom change in the fatigue-related symptom cluster in patients receiving immunotherapy for lung cancer. A small number of patients showed a trend of persistent worsening of appetite loss and pain. Future studies may continue to analyze intervention nodes based on symptom profile categories and help healthcare professionals identify key populations through influencing factors to provide personalized and holistic symptom management for patients with lung cancer receiving immunotherapy.更多还原