AECOPD老年患者生理与心理生命质量的交叉滞后因果分析  

Cross-lagged causal analysis of physiological and psychological quality of life in elderly patients with acute exacerbation of chronic obstructive pulmonary disease

作　　者：胡象文 何航帜 李莉芳[2] 胡晓娟 姬祎姗 张岩波 赵卉[2] HU Xiangwen;HE Hangzhi;LI Lifang;HU Xiaojuan;JI Yishan;ZHANG Yanbo;ZHAO Hui(Department of Statistics,School of Public Health,Shanxi Medical University,Taiyuan 030001,China;Department of Respiratory and Critical Care Medicine,Second Hospital of Shanxi Medical University;Department of Medical information technology,School of Management,Shanxi Medical University;Shanxi Provincial Key Laboratory of Major Disease Risk Assessment)

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030001 [2]山西医科大学第二医院呼吸与危重症医学科 [3]山西医科大学管理学院医学信息技术教研室 [4]重大疾病风险评估山西省重点实验室

出　　处：《山西医科大学学报》2025年第3期299-310,共12页Journal of Shanxi Medical University

基　　金：国家自然科学基金项目(81872714);山西省科技合作交流专项(202204041101031)。

摘　　要：目的采用患者报告结局(PRO)分析慢性阻塞性肺疾病急性加重(AECOPD)老年患者生理与心理状况的因果效应,并分层探讨这些因素间的相互影响。方法对2021年9月至2022年12月山西医科大学第二医院和太原市人民医院等5家医院采用随机抽样方法选取就诊的220例AECOPD住院患者,入院时(T_(1))进行基线调查,在出院后3个月时(T_(2))电话随访。用参数与非参数检验分析影响AECOPD老年患者生命质量的社会心理和临床因素并通过交叉滞后模型(CLPM)分析生理和心理状态的相互影响。根据年龄对AECOPD老年患者分层,分为高龄老年组(≥70岁)和低龄老年组(<70岁),并对总人群以及高、低龄老年组患者的生理与心理生命质量进行分层分析。结果在全人群老年患者中生理和心理状态存在相互预测关系,即T_(1)时生理状态可预测T2时心理状态(β=0.570,P<0.001),T_(1)时心理状态可预测T2时生理状态(β=0.129,P=0.026)。影响因素分层分析结果显示,高龄老年组与低龄老年组在性别、婚姻状况、家族史及吸烟情况方面存在差异。全人群和年龄分层分析的数据均表明,全身症状与焦虑和抑郁之间存在显著的相互预测关系。全人群和分层分析表明T_(1)时全身症状能够显著预测T2时抑郁状态(β=0.472,P<0.001),T_(1)时抑郁状态也能显著预测T_(2)时全身症状(β=0.361,P<0.001)。同样地,在全人群老年患者中T_(1)时全身症状能够显著预测T_(2)时焦虑状态(β=0.235,P<0.001),T_(1)时焦虑状态也显著预测T_(2)时全身症状(β=0.143,P<0.001)。全人群老年患者中独立性与焦虑之间存在显著的相互预测关系,T_(1)时独立性状态显著预测T_(2)时焦虑状态(β=0.185,P=0.010),T_(1)时焦虑状态也显著预测T_(2)时独立性状态(β=0.936,P<0.001);该独立性与焦虑间的交叉滞后关系在年龄分层分析中得到一致验证。结论AECOPD老年患者的生理领域和心理领域之间存在双向�Objective To investigate the causal effects of physiological and psychological status in elderly patients with acute exacerbation of chronic obstructive pulmonary disease(AECOPD)using patient-reported outcomes(PRO)and explore the interactions between these factors after age stratification.Methods A total of 220 hospitalized AECOPD patients were randomly selected from five hospitals,such as Second Hospital of Shanxi Medical University and Taiyuan People's Hospital,from September 2021 to December2022.Baseline data were collected at admission(T_(1)),and the patients were followed up by telephone three months after discharge(T_(2)).Parametric and non-parametric tests were performed to analyze socio-psychological and clinical factors influencing the quality of life of elderly AECOPD patients.Cross-lagged panel model(CLPM)was used to examine the mutual influence between physiological and psychological states.Patients were stratified into two groups based on age:≥70 years old group and<70 years old group,and the physiological and psychological quality of life and their interaction were analyzed after stratification.Methods In the total population,a significant mutual predictive relationship was observed between physiological and psychological states.Specifically,physiological status at T_(1)significantly predicted psychological status at T_(2)(β=0.570,P<0.001),while psychological status at T_(1)significantly predicted physiological status at T_(2)(β=0.129,P=0.026).Stratified analyses revealed differences in gender,marital status,family history,and smoking status between≥70 years old group and<70 years old group.For both the total population and patients after age stratification,systemic symptoms demonstrated significant mutual predictive relationships with anxiety and depression.Specifically,systemic symptoms at T_(1)significantly predicted depressive status at T_(2)(β=0.472,P<0.001),and depressive status at T_(1)significantly predicted systemic symptoms at T_(2)(β=0.361,P<0.001).Similarly,systemic symptoms at T

关 键 词：慢性阻塞性肺疾病急性加重 患者报告结局 生理领域 心理领域 生命质量 抑郁 焦虑 交叉滞后分析 

分 类 号：R563[医药卫生—呼吸系统]