慢性心力衰竭患者躯体症状与心理状态的交叉滞后研究

李晨昊; 朱晓芳; 田晶; 闫晶晶; 张青; 韩嫱; 韩清华; 张岩波

doi:10.16462/j.cnki.zhjbkz.2021.03.012

慢性心力衰竭患者躯体症状与心理状态的交叉滞后研究

doi: 10.16462/j.cnki.zhjbkz.2021.03.012

李晨昊^{1, 3},
朱晓芳¹,
田晶²,
闫晶晶^{1, 3},
张青²,
韩嫱^{1, 3},
韩清华^2, ,,
张岩波^{1, 3, ,}

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

基金项目:

国家自然科学基金 81872714

山西省重点实验室 201805D111006

详细信息

通讯作者:
张岩波，E-mail: sxmuzyb@126.com

韩清华，E-mail: syhqh@sohu.com

中图分类号: R541.6
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- 文章访问数: 361
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出版历程
- 收稿日期: 2020-07-19
- 修回日期: 2020-12-09
- 刊出日期: 2021-03-10

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

LI Chen-hao^{1, 3},
ZHU Xiao-fang¹,
TIAN Jing²,
YAN Jing-jing^{1, 3},
ZHANG Qing²,
HAN Qiang^{1, 3},
HAN Qing-hua^{2
, ,},
ZHANG Yan-bo^{1, 3
, ,}

1.
Department of Health Statistics, School of Pubilc Health, Shanxi Medical University, Taiyuan 030000, China
2.
Department of Cardiology, First Affiliated Hospital, Shanxi Medical University, Taiyuan 030000, China
3.
Shanxi Provincial Key Laboratory of Major Diseases Risk Assessment, Taiyuan 030000, China

Funds:

National Natural Science Foundation of China 81872714

Provincial Key Laboratory of Shanxi 201805D111006

More Information

Corresponding author: HAN Qing-hua, E-mail: syhqh@sohu.com; ZHANG Yan-bo, E-mail: sxmuzyb@126.com

摘要

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。
- 慢性心力衰竭 /
- 躯体症状 /
- 心理状态 /
- 交叉滞后回归分析
Abstract: 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.
- Chronic heart failure /
- Somatic symptoms /
- Mental states /
- Cross-lagged regression analysis

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图 1 交叉滞后模型

注：T1表示前测，T2表示后测；双箭头表示相关系数，单箭头表示路径系数；单箭头实线表示路径系数有统计学意义。

Figure 1. Cross-lagged regression

下载: 全尺寸图片幻灯片

图 2 躯体症状与心理状态的交叉滞后回归分析模型

注：T1表示前测，T2表示后测；^a表示P < 0.01，^b表示P < 0.05；双箭头表示相关系数，单箭头表示路径系数；单箭头实线表示路径系数有统计学意义，单箭头虚线表示无统计学意义。

Figure 2. Cross-lagged regression analysis of somatic symptoms and mental states

下载: 全尺寸图片幻灯片

图 3 躯体症状与焦虑的交叉滞后回归分析模型

Figure 3. Cross-lagged regression analysis of somatic symptoms and anxiety

下载: 全尺寸图片幻灯片

表 1 CHF患者的一般情况[n(%)]

Table 1. General situation of patients with CHF [n(%)]

变量	人数	百分比(%)
年龄(岁)
< 55	49	18.7
55~	43	16.4
65~	69	26.4
≥75	101	38.5
性别
男性	148	56.5
女性	114	43.5
婚姻状况
未婚	4	1.5
已婚	211	80.6
离异	4	1.5
丧偶	43	16.4
文化程度
文盲	22	8.4
小学	64	24.4
初中	96	36.6
高中(含中专)	38	14.5
大专	28	10.7
本科及以上	14	5.3
家庭收入
低	118	45.0
中	140	53.5
高	4	1.5
家族史
无	174	66.4
有	88	33.6
既往史
无	107	40.8
有	155	59.2
NYHA
Ⅰ级	10	3.8
Ⅱ级	71	27.1
Ⅲ级	121	46.2
Ⅳ级	60	22.9

下载: 导出CSV

表 2 CHF患者躯体症状和心理状态及各维度得分情况(x±s)

Table 2. Scores of somatic symptoms, mental state and various dimensions in patients with CHF (x±s)

项目	T1(分)			T2(分)
项目	男	女	总体	男	女	总体
躯体症状	30.54±5.50	29.32±5.90	30.01±5.72	37.59±2.38	36.71±3.20	37.21±2.80
心理状态	91.55±11.82	84.71±13.21	88.58±12.88	101.73±3.96	99.41±6.62	100.72±5.40
焦虑	31.70±6.06	27.83±6.56	30.02±6.56	37.57±2.88	36.05±4.07	36.91±3.53
抑郁	26.80±4.24	24.87± 4.73	25.96±4.56	29.30±1.11	28.80±1.72	29.08±1.43
恐惧	13.89±1.70	13.19±2.44	13.59±2.08	14.86±0.45	14.71±0.94	14.80±0.71
偏执	19.16±1.88	19.16±1.88	19.01±2.09	19.99±0.07	19.85±0.90	19.93±0.60

下载: 导出CSV

表 3 躯体症状与心理状态的相关

Table 3. Correlation between somatic symptoms and mental state

项目	T1SOM	T2SOM	T1PSY	T2PSY
T1SOM	1.000
T2SOM	0.246^a	1.000
T1PSY	0.331^a	0.247^a	1.000
T2PSY	0.086	0.445^a	0.405^a	1.000
注：^a表示P < 0.01。

下载: 导出CSV

表 4 躯体症状与心理领域各维度的相关

Table 4. Correlation between somatic symptoms and dimensions of psychological field

项目	T1SOM	T2SOM	T1ANX	T2ANX	T1DEP	T2DEP	T1FEA	T2FEA	T1PAR	T2PAR
T1SOM	1.000
T2SOM	0.246^a	1.000
T1ANX	0.343^a	0.268^a	1.000
T2ANX	0.083	0.407^a	0.423^a	1.000
T1DEP	0.211^a	0.184^a	0.670^a	0.271^a	1.000
T2DEP	0.086	0.380^a	0.364^a	0.739^a	0.355^a	1.000
T1FEA	0.274^a	0.178^a	0.543^a	0.240^a	0.667^a	0.311^a	1.000
T2FEA	0.013	0.337^a	0.221^a	0.442^a	0.222^a	0.605^a	0.185^a	1.000
T1PAR	0.228^a	0.101	0.436^a	0.125b	0.487^a	0.142b	0.528^a	0.098	1.000
T2PAR	0.068	0.306^a	0.201^a	0.304^a	0.283^a	0.543^a	0.252^a	0.812^a	0.175^a	1.000
注：^a表示P < 0.01；^b表示P < 0.05。

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参考文献(20)

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慢性心力衰竭患者躯体症状与心理状态的交叉滞后研究

doi: 10.16462/j.cnki.zhjbkz.2021.03.012

通讯作者:
张岩波，E-mail: sxmuzyb@126.com

韩清华，E-mail: syhqh@sohu.com

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

Corresponding author: HAN Qing-hua, E-mail: syhqh@sohu.com; ZHANG Yan-bo, E-mail: sxmuzyb@126.com

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慢性心力衰竭患者躯体症状与心理状态的交叉滞后研究

doi: 10.16462/j.cnki.zhjbkz.2021.03.012

通讯作者: 张岩波，E-mail: sxmuzyb@126.com 韩清华，E-mail: syhqh@sohu.com

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出版历程

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

Corresponding author: HAN Qing-hua, E-mail: syhqh@sohu.com; ZHANG Yan-bo, E-mail: sxmuzyb@126.com

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出版历程

目录

通讯作者:
张岩波，E-mail: sxmuzyb@126.com

韩清华，E-mail: syhqh@sohu.com