基于结构方程对Ⅱ型糖尿病病人生活质量及影响因素的分析  

Analysis on quality of life and its influencing factors in patients with type 2 diabetes based on structural equation model

作　　者：周楠 杨贶 刘颖 易尚辉[1] 查文婷[1] 吕媛[1] ZHOU Nan;YANG Kuang;LIU Ying;YI Shang-hui;ZHA Wen-ting;LYU Yuan(Medical College of Hunan Normal University,Changsha,Hunan 410001,China)

机构地区：[1]湖南师范大学医学院,湖南长沙410001

出　　处：《实用预防医学》2020年第10期1158-1162,共5页Practical Preventive Medicine

基　　金：湖南师范大学分子流行病学湖南省重点实验室资助(81773530);湖南省教育厅项目(湘教通[2017]452号)。

摘　　要：目的分析Ⅱ型糖尿病病人生活质量的影响因素,为综合制定合理措施改善患者生存质量提供科学依据。方法采用多阶段随机整群抽样,从长沙市9个区、县(市)中随机抽取3个,再从每个区中随机抽取1个镇(街道),对抽中的3个镇(街道)辖区内管理的Ⅱ型糖尿病患者进行问卷调查与健康体检。根据变量数量对原始数据进行降维,构建结构方程模型,采用SPSS中的AMOS 22.0程序包进行模型拟合及检验。结果本次共调查糖尿病患者3338例,其中男性1643(49.22%)例,女性1695(50.78%)例;年龄以60~70岁为主,占42.12%(1406/3338)。并发高血压所占比例最大,占68.5%,其次为肾脏疾病(19.3%)、脑血管疾病(11.6%)等。χ2检验显示,年龄、患者病程、治疗情况、腰臀比和社会经济地位(如文化程度低、农村农民占多数)在糖尿病患者中有无慢性并发症差异有统计学意义(P<0.05),而性别、婚姻状况、吸烟、饮酒、体力活动、BMI分布情况等差异无统计学意义(P>0.05)。通过结构方程因子降维结果选取部分指标进行结构方程模型的拟合,拟合结果显示GFI=0.995,AGFI=0.989,TLI=0.9440,RMSEA=0.042,CFI=0.966,NFI=0.961。模型拟合较好,文化程度、生活质量、吸烟、饮酒以及体力活动以及家族遗传之间存在相互关系,其中体力活动对Ⅱ型糖尿病患者的生活质量存在较大影响,其次为文化程度。结论通过加强体力活动以及减少吸烟饮酒能够有效提升Ⅱ型糖尿病病人的生活质量。Objective To analyze the factors influencing quality of life in patients with type 2 diabetes,and to provide a scientific basis for comprehensively formulating reasonable measures to improve the patients’quality of life.Methods A multistage random cluster sampling method was used to select three districts from nine districts and counties(cities)in Changsha,and then one town(street)was randomly chosen from each district selected.Questionnaire surveys and physical examinations were conducted on type 2 diabetes patients managed in the three towns(streets)selected.The original data were dimension-reduced according to the number of variables,and the structural equation model was constructed.The model was fitted by the AMOS 22.0 package in SPSS.Results A total of 3,338 patients with type 2 diabetes were investigated,including 1,643(49.22%)males and 1,695(50.78%)females.Most of the patients ranged in age from 60 to 70 years,accounting for 42.12%(1,406/3,338).The proportion of type 2 diabetes patients complicated by hypertension was the highest(68.5%),followed by kidney disease(19.3%)and cerebrovascular disease(11.6%).Chi-square test showed that there were statistically significant differences in age,duration of disease,treatment status,waist-hip ratio,and socioeconomic status(such as poor educational background and majority of rural farmers)between type 2 diabetes patients with and without chronic complications(all P<0.05),but no statistically significant differences were found in gender,marital status,smoking,drinking,physical activity,distribution of body mass index and other conditions between type 2 diabetes patients with and without chronic complications(all P>0.05).Some indicators were selected to fit the structural equation model according to the factor reduction results.The fitting results showed that goodness of fit index(GFI),adjusted goodness of fit index(AGFI),Tucker-Lewis index(TLI),rot mean square error of approximation(RMSEA),comparative fit index(CFI),and normed fit index(NFI)were 0.995,0.989,0.9440,0.

关 键 词：Ⅱ型糖尿病 结构方程 生存质量 影响因素 

分 类 号：R587.1[医药卫生—内分泌]