基于交叉滞后模型的COPD患者心理-社会因果效应分析  

Psychological-social causal effect analysis in COPD patients based on cross-lagged model

作　　者：姬祎姗 何航帜 李莉芳[2] 胡晓娟 胡象文 张岩波 赵卉[2] JI Yishan;HE Hangzhi;LI Lifang;HU Xiaojuan;HU Xiangwen;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311-319,共9页Journal of Shanxi Medical University

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

摘　　要：目的采用患者报告结局(PRO)探索慢性阻塞性肺病(COPD)患者心理状态和社会状态的因果滞后效应。方法于2020年12月至2023年10月对山西省太原市5家医院的218例COPD住院患者入院时(T_(1))进行基线调查,在其出院后3个月(T_(2))和出院后6个月(T_(3))进行电话随访。采用交叉滞后模型(CLPM)分析心理状态(包括焦虑、抑郁2个维度)和社会状态(包括疾病认知、疾病对社会活动的影响、社会支持3个维度)的因果时序关系及交叉作用,并根据mMRC评估的基线呼吸困难程度分层分析COPD患者的心理状态和社会状态的因果时序关系及交叉作用。结果T_(2)时焦虑评分显著正向预测T_(3)时疾病认知评分(β=0.603,P<0.05);前一个时间点的疾病对社会活动的影响评分均可显著正向预测后一个时间点的焦虑评分(β_((T_(1)-T_(2))=0.922,P<0.05;β_(T_(2)-T_(3))=0.951,P<0.05);前一个时间点的疾病对社会活动的影响评分均可显著正向预测后一个时间点的抑郁评分(β_((T_(1)-T_(2))=0.820,P<0.05;β_(T_(2)-T_(3))=0.890,P<0.05);T_(2)时抑郁评分可显著正向预测T_(3)时疾病对社会活动的影响评分(β=0.330,P<0.05);T_(1)时社会支持评分可显著正向预测T_(2)时焦虑评分(β=0.426,P<0.05);T_(2)时社会支持评分可显著正向预测T_(2)时焦虑评分(β=0.609,P<0.05);前一个时间点的社会支持评分均可显著正向预测后一个时间点的抑郁评分(β_((T_(1)-T_(2))=0.420,P<0.05;β_(T_(2)-T_(3))-0.297,P<0.05);T_(2)时抑郁评分可显著负向预测T_(3)时社会支持评分(β=-0.361,P<0.05)。T_(2)和T_(3)时呼吸困难程度较重的患者焦虑评分可以显著正向预测疾病对社会活动的影响评分(β=0.151,P<0.05),疾病对社会活动的影响评分可以显著正向预测抑郁评分(β=0.337,P<0.05)。结论慢性阻塞性肺病住院患者的心理领域和社会领域之间存在因果关系,其中疾病对社会活动的影响和社会支持与焦虑、抑郁的因果关系�Objective To investigate the causal lag effects of psychological and social status in patients with chronic obstructive pulmonary disease(COPD)using patient-reported outcomes(PRO).Methods A baseline survey was conducted on 218 hospitalized COPD patients on admission(T_(1))in five hospitals in Taiyuan,Shanxi province,from December 2020 to October 2023.Follow-up telephone surveys were carried out three months(T_(2))and six months(T_(3))after discharge.The cross-lagged panel model(CLPM)was employed to analyze the causal and temporal relationships and interactions between psychological status(anxiety and depression)and social status(disease cognition,influence of disease on social activities,and social support).Stratified analysis was performed based on baseline dyspnea severity assessed using the mMRC scale to examine the causal and temporal relationships and interactions between psychological and social status in COPD patients.Results Anxiety scores at T_(2)significantly positively predicted disease perception scores at T_(3)(β=0.603,P<0.05).The influence of disease on social activities at the previous time point significantly positively predicted anxiety scores at the subsequent time point(β_(T_(1)-T_(2))=0.922,P<0.05;β_(T_(2)-T_(3))=0.951,P<0.05).Similarly,the influence of disease on social activities at the previous time point significantly positively predicted depression scores at the subsequent time point(β_(T_(1)-T_(2))=0.820,P<0.05;β_(T_(2)-T_(3))=0.890,P<0.05).Depression scores at T2 significantly positively predicted the influence of disease on social activities at T_(3)(β=0.330,P<0.05).Social support scores at T_(1)significantly positively predicted anxiety scores at T_(2)(β=0.426,P<0.05),and social support scores at T_(2)significantly positively predicted anxiety scores at T_(2)(β=0.609,P<0.05).Social support scores at the previous time point significantly positively predicted depression scores at the subsequent time point(β_(T_(1)-T_(2))=0.420,P<0.05;β_(T_(2)-T_(3))=0.297,P<0.05).Conversely,de

关 键 词：慢性阻塞性肺病 患者报告结局 心理因素 社会因素 交叉滞后分析 因果时序关系 

分 类 号：R749.2[医药卫生—神经病学与精神病学]