Change curve and analysis of social frailty in maintenance hemodialysis patients
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摘要:
目的 了解维持性血液透析患者在不同世界节点的社会衰弱状况，分析社会衰弱动态轨迹并探讨不同轨迹分布差异的影响因素。 方法 选取2020年4月—2022年10月南通市第三人民医院收治的维持性血液透析患者155例作为调查对象。在不同时间节点采用基本信息调查表、中文版社会衰弱指数量表及社会支持评定量表对患者进行问卷调查。采用潜类别增长模型识别维持性血液透析患者社会衰弱的不同轨迹。 结果 透析患者社会衰弱轨迹存在3个潜在类别，每个类别的维持性血液透析患者归属于各个潜在类别的平均概率分别为0.944、0.908、0.946。3个类别分别为高水平加重组(30.3%)、中水平改善组(51.8%)、中低水平平稳组(17.9%)。不同轨迹类别患者年龄(H=11.773，P=0.019)、性别(χ2=7.618，P=0.022)、自评性格类型(χ2=10.016，P=0.040)、患病后是否继续工作(χ2=10.512，P=0.005)、社会支持得分(F=7.362，P＜0.001)差异均有统计学意义。 结论 维持性血液透析患者社会衰弱存在3种不同变化轨迹，患者社会衰弱轨迹存在差异，且受到年龄、性别、自评性格类型、患病后是否继续工作及社会支持等多方面的影响。临床工作人员应密切关注高水平加重组的维持性血液透析患者，及时识别社会衰弱的高危患者，以降低社会衰弱带来的影响，并提供积极的、有针对性的保护性措施。 Abstract:Objective To examine the dynamic trajectories of social frailty in maintenance hemodialysis patients and the factors that influence these trajectories. Methods A total of 155 patients receiving maintenance hemodialysis who were admitted to the hospital between April 2020 and October 2022 were selected for inclusion in the study. At different time points, the subjects were asked to complete a basic information questionnaire, and the Chinese version of the social frailty index scale and the social support rating scale were used. These tools were used to identify different trajectories of social decline in patients receiving maintenance hemodialysis. The latent class growth model was then used to identify these trajectories. Results The present study posits that three potential categories of social frailty trajectories exist among dialysis patients with the average probability of 0.944, 0.908 and 0.946, respectively, for maintenance hemodialysis patients to belong to each category. The categories are as follows: social faltering plus restructuring (30.3%), social faltering improvement group (51.8%), and social faltering stabilization group (17.9%). The analysis revealed a statistically significant association between age (H=11.773, P=0.019), gender (χ2=7.618, P=0.022), and self-rated personality type (χ2=10.016, P=0.040), whether or not the participant was still working after contracting an illness (χ2=10.512, P=0.005), and the social support score (F=7.362, P < 0.001). The differences were statistically significant. Conclusion It is evident that three distinct trajectories of social frailty are observable in maintenance hemodialysis patients, These trajectories are influenced by various factors, including age, gender, self-rated personality type, employment status post-illness and social support. Clinical staff must exercise caution when monitoring dialysis patients exhibiting social frailty in conjunction with recombination, as it is imperative to identify high-risk patients with social frailty in a timely manner to mitigate the repercussions of social frailty. Furthermore, it is crucial to provide active proactive and targeted protective care. -
Key words:
- Maintenance hemodialysis /
- Social frailty /
- Curve /
- Trajectory /
- Longitudinal study /
- Influencing factor
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图 1 维持性血液透析患者社会衰弱发展潜类别增长模型轨迹
Figure 1. Trajectory of potential category growth model for social futility development in maintenance hemodialysis patients
表 1 社会衰弱变化轨迹拟合指标(n=122)
Table 1. Indicators for fitting trajectories of social frailty changes (n=122)
模型 参量 Log(L) AIC BIC aBIC LMR BLRT Entropy 类别概率 1 5 -996.254 6 120.702 6 163.672 6 113.563 2 8 -933.540 5 822.314 5 722.266 5 701.733 0.069 0.000 0.788 0.230/0.770 3 11 -901.171 5 671.528 5 540.445 5 511.413 0.004 0.000 0.846 0.303/0.518/0.179 4 14 -881.657 5 484.854 5 341.794 5 374.247 0.147 0.000 0.879 0.329/0.341/0.092/0.238 5 17 -852.731 5 265.146 5 262.288 5 231.238 0.567 0.126 0.898 0.272/0.117/0.061/0.329/0.221 
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表 2 社会衰弱变化轨迹平均归属3个潜在类别的概率
Table 2. The average probability of social decline trajectory belonging to three potential categories
模型 C1 C2 C3 C1 0.944 0.021 0.035 C2 0.064 0.908 0.028 C3 0.022 0.032 0.946
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表 3 社会衰弱不同潜在类别单因素分析结果
Table 3. Results of univariate analysis of different potential categories of social faltering
项目 高水平加重组(n=37) 中水平改善组(n=63) 中低水平平稳组(n=22) 统计量 P值 年龄[例(%)] 11.773a 0.019 ＜45岁 5(13.5) 15(23.8) 6(27.3) 45~59岁 10(27.0) 31(49.2) 6(27.3) ≥60岁 22(59.5) 17(27.0) 10(45.4) 性别[例(%)] 7.618b 0.022 男性 17(45.9) 46(73.0) 15(68.2) 女性 20(54.1) 17(27.0) 7(31.8) 婚姻状况[例(%)] 1.264b 0.532 单身 4(10.8) 4(6.3) 3(13.6) 已婚 33(89.2) 59(93.7) 19(86.4) 文化程度[例(%)] 1.891a 0.389 初中及以下 5(13.5) 14(22.2) 3(13.6) 高中/高职/中专 12(32.4) 20(31.7) 6(27.3) 大专 9(24.3) 18(28.6) 9(40.9) 本科及以上 11(29.8) 11(17.5) 4(18.2) 家庭人均月收入[例(%)] 3.769a 0.438 ＜3 000元 7(18.9) 14(22.2) 3(13.6) 3 000~7 000元 24(64.9) 40(63.5) 12(54.5) ＞7 000元 6(16.2) 9(14.3) 7(31.9) 居住地[例(%)] 3.331b 0.504 城市 7(18.9) 20(31.7) 5(22.7) 乡镇 11(29.7) 22(34.9) 7(31.8) 农村 19(51.35) 21(33.4) 10(45.5) 自评性格类型[例(%)] 10.016b 0.040 内向型 17(56.9) 17(27.0) 5(22.7) 中间型 16(43.2) 36(57.1) 9(40.9) 外向型 4(10.9) 10(15.9) 8(36.4) 患病后继续工作[例(%)] 10.512b 0.005 是 9(24.3) 15(23.8) 13(59.1) 否 28(75.7) 48(76.2) 9(40.9) 社会支持(x ±s, 分) 34.52±5.55 39.67±5.85 45.39±6.12 7.362c ＜0.001 注：a为H值，b为χ2值，c为F值。
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