潜变量增长混合模型在慢性心衰患者生理症状变化轨迹研究中的应用

Application of Latent Growth Mixture Modeling in the Study of the Trajectory of Physiological Symptoms in Patients with Chronic Heart Failure

目的分析慢性心力衰竭(chronic heart failure,CHF)患者报告结局(patient-reported outcomes,PRO)纵向随访数据,探索不同潜在亚类及个体发展轨迹。方法纳入2017年5月-2019年6月山西三所三甲医院的286例CHF患者,选取患者住院时、出院后6、12、18、24月的CHF-PRO数据,对患者的生理领域及躯体状况、食欲睡眠和身体独立三个维度拟合潜变量增长混合模型,识别异质性亚类及个体轨迹变化规律。结果生理领域和各维度变化轨迹存在差异。生理领域中3类二次函数模型最优,第一潜在亚类随时间先下降后上升,第二、三潜在亚类随时间先上升后趋于平稳。躯体症状维度中3类非定义曲线模型最优,3个潜在亚类都是先上升后趋于平稳。食欲睡眠维度2类二次函数模型最优,第一、二潜在亚类随时间先上升,之后第二潜在亚类出现下降趋势。身体独立维度2个潜在亚类整体好转,最后均趋于平稳。结论患者出院后CHF-PRO的生理领域及各维度水平变化存在不同亚类及个体发展轨迹,对患者给予针对性干预措施具有重要作用。

Objective The longitudinal follow-up data of patient-reported outcomes of patients with chronic heart failure were analyzed to explore different latent classes and individual development trajectories.Methods A total of 286 patients with CHF were consecutively enrolled from the top three hospitals in Shanxi Province from May 2017 to June 2019.We used data from baseline and 6,12,18 and 24 months of follow-up.Physiological domain,somatization,appetite sleep,independence dimensions were fitted to identify heterogeneous subgroups and patterns of change in individual trajectories.Results There were differences in the trajectories of physiological domains and each dimension.In the domain of physiology,the 3-class of quadratic model was the best-fitting model.The first latent class showed a trend of decline first and then elevation over time,the second and third subgroups showed trends of elevation first and then stable change.The 3-class of undefined curve model in the somatic symptom was the best-fitting model,and the three latent subgroups demonstrated elevation first and then stable change over time.The two-class of quadratic model of appetite sleep was best-fitting model.The first and second subgroups showed trends of elevation first and then the second latent subgroup showed a trend of decreasing over time.The two subgroups of independence improved overall,and finally stabilized.Conclusion There are different subgroups and individual development trajectories in the physiological domains and various dimensions of CHF-PRO,which plays an important role in providing targeted interventions to the patients.