摘要
目的评估慢性心力衰竭患者报告结局量表(patient reported outcomes measure with chronic heart failure,CHF-PROM)纵向数据中心理领域的纵向测量不变性并探索不同时间点心理与生理领域各维度的因果关系。方法纳入2019年5月20日到2022年6月24日山西省两所三甲医院明确诊断为慢性心力衰竭患者481例,收集患者住院时基线(T1)、出院后6月(T2)、12月(T3)的CHF-PROM数据。评估心理领域的纵向测量不变性,应用随机截距交叉滞后模型(random intercept cross-lagged panel model,RI-CLPM)研究不同时间点心理和生理领域各维度的因果关系并与传统交叉滞后模型(cross-lagged panel model,CLPM)进行比较。结果纵向测量不变性结果表明,心理领域中的形态等值模型、单位等值模型和尺度等值模型拟合良好,后两者比较拟合指数的差值均大于界值但近似均方根误差的差值未达到差异变化的界值。RI-CLPM的拟合指标优于CLPM。T1时刻的恐惧正向预测T2时刻的躯体症状(β=0.179,P=0.006),T2时刻的躯体症状正向预测T3时刻的恐惧(β=0.175,P=0.026)。T1时刻的偏执正向预测T2时刻的躯体症状(β=0.117,P=0.049),T2时刻的躯体症状正向预测T3时刻的偏执(β=0.241,P=0.005)。结论RI-CLPM有效探讨慢性心力衰竭患者生理和心理领域中躯体症状与恐惧、躯体症状与偏执的因果关系。缓解患者心理状态可改善躯体症状,良好的躯体症状也可以减少恐惧、偏执。
Objective This study evaluated the longitudinal invariance level of psychological domain about the longitudinal data of patient reported outcomes measure with chronic heart failure(CHF-PROM)and explored the causal relationship between psychological and physiological dimensions at different time points.Methods A total of 481 patients diagnosed with chronic heart failure were collected from the top two hospitals in Shanxi Province from May 20th,2019 to June 24th,2022.CHF-PROM follow-up was performed at baseline(T1),6 months(T2),and 12 months(T3).The level of longitudinal measurement invariance in the psychological field of CHF-PROM was evaluated.The random intercept cross-lagged panel model(RI-CLPM)was used to study the causal relationship between psychological and physiological domains at different time points,and compared with the traditional cross-lagged panel model(CLPM).Results The results of longitudinal measurement invariance showed that the configural invariance,metric invariance and scalar invariance of the physical domain were well fitted.TheΔCFI of the latter two were larger than the boundary value,but theΔRMSEA did not reach the boundary value of difference change.The fitting indices of the RI-CLPM is better than the CLPM.Fear at T1 positively predicted somatic symptoms at T2(β=0.179,P=0.006),and somatic symptoms at T2 positively predicted fear at T3(β=0.175,P=0.026).Paranoia at T1 positively predicted somatic symptoms at T2(β=0.117,P=0.049),and somatic symptoms at T2 positively predicted paranoia at T3(β=0.241,P=0.005).Conclusion The RI-CLPM was constructed to explore the causal relationship between somatic symptoms and fear,as well as somatic symptoms and paranoia,in both the physiological and psychological domains of CHF patients effectively.Relieving the patient's psychological state can improve the somatic symptoms,and good somatic symptoms can also reduce fear and paranoia.
作者
张欣雨
冯佳雨
田晶
闫晶晶
韩港飞
和紫铉
张岩波
Zhang Xinyu;Feng Jiayu;Tian Jing(Department of Health Statistics,School of Public Health,Shanxi Medical University,Taiyuan 030001)
出处
《中国卫生统计》
北大核心
2025年第6期856-861,共6页
Chinese Journal of Health Statistics
基金
国家自然科学基金(82173631,82103958)。
关键词
慢性心力衰竭
交叉滞后模型
随机截距交叉滞后模型
个体内效应
纵向测量不变性
Chronic heart failure
Cross-lagged panel model
Random intercept cross-lagged panel model
Within-person effect
Longitudinal measurement invariance
