慢性心力衰竭患者躯体症状与心理状态的交叉滞后研究  

A cross-lagged study of somatic symptoms and mental states in patients with chronic heart failure

作　　者：李晨昊 朱晓芳 田晶[2] 闫晶晶 张青[2] 韩嫱 韩清华[2] 张岩波 LI Chen-hao;ZHU Xiao-fang;TIAN Jing;YAN Jing-jing;ZHANG Qing;HAN Qiang;HAN Qing-hua;ZHANG Yan-bo(Department of Health Statistics,School of Pubilc Health,Shanxi Medical University,Taiyuan 030000,China;Department of Cardiology,First Affiliated Hospital,Shanxi Medical University,Taiyuan 030000,China;Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment,Taiyuan 030000,China)

机构地区：[1]山西医科大学公共卫生学院卫生统计学教研室,太原030000 [2]山西医科大学第一附属医院心内科,太原030000 [3]重大疾病风险评估山西省重点实验室,太原030000

出　　处：《中华疾病控制杂志》2021年第3期311-316,共6页Chinese Journal of Disease Control & Prevention

基　　金：国家自然科学基金81872714;山西省重点实验室201805D111006。

摘　　要：目的采用交叉滞后回归分析模型探究慢性心力衰竭(chronic heart failure,CHF)患者躯体症状与心理状态之间的相互作用。方法选取2017年11月—2018年12月在山西省2家三甲医院心内科住院的262名慢性心衰患者,进行6个月的纵向追踪。采用心力衰竭患者报告结局调查问卷(patient-reported outcome measure for chronic heart failure,CHF-PROM)先后2次进行测量(T1和T2),采用交叉滞后回归模型分析躯体症状和心理状态之间的关系。结果慢性心力衰竭患者躯体症状和心理状态均具有一定稳定性。2次测量的躯体症状和心理状态均成正相关(r=0.331,P<0.001;r=0.445,P<0.001)。交叉滞后回归分析显示,控制T1躯体症状后,T1心理状态可以预测T2躯体症状(β=0.163,P=0.010);进一步分析心理状态各维度显示,控制T1躯体症状后,T1焦虑可以预测T2躯体症状(β=0.183,P=0.004)。结论心理状态是躯体症状的前因变量,心理状态可以正向预测躯体症状。进一步分析显示,焦虑是躯体症状的前因变量,焦虑对躯体症状具有正向预测作用。Objective The cross-lagged regression model was used to investigate the interaction between somatic symptoms and mental states in patients with chronic heart failure(CHF).Methods A six-month longitudinal follow-up was conducted amongst 262 patients with chronic heart failure who were admitted to the Department of Cardiology of two of the top three hospitals in Shanxi Province from November 2017 to December 2018.The patient-reported outcomes instrument for CHF(patient-reported outcome measure for chronic heart failure,CHF-PROM)was used for two measurements(T1 and T2),Cross-lagged regression model was used to analyze the relationship between somatic symptoms and mental states.Results The physical symptoms and mental states of patients with chronic heart failure were stable.There was a positive correlation between physical symptoms and mental states(r=0.331,P<0.001;r=0.445,P<0.001).Cross-lagged regression analysis showed that after controlling for T1 somatic symptoms,T1 mental states could predict T2 somatic symptoms(β=0.163,P=0.010);Further analysis of the psychological state of each dimension showed that T1 anxiety predicted somatic symptoms of T2(β=0.183,P=0.004)after controlling for T1 somatic symptoms.Conclusions Mental states are the antecedents of somatic symptoms,which can positively predict somatic symptoms.Further analysis showed that anxiety is the antecedent variable of somatic symptoms and anxiety has a significant positive predictive effect on somatic symptoms.

关 键 词：慢性心力衰竭 躯体症状 心理状态 交叉滞后回归分析 

分 类 号：R541.6[医药卫生—心血管疾病]