稳定期慢性阻塞性肺疾病患者久坐行为与生命质量之间的关系:衰弱的中介作用

Relationship between sedentary behavior and quality of life in stable chronic obstructive pulmonary disease patients:the mediating role of frailty

目的探讨衰弱在稳定期慢性阻塞性肺疾病(COPD)患者久坐行为与生命质量之间的中介作用,为改善稳定期COPD患者的生命质量提供实证依据。方法采用便利抽样法选取2022年1月至2023年2月上海市第十人民医院崇明分院门诊就诊的228例稳定期COPD患者为研究对象,使用一般资料调查表、国际体力活动问卷、Tilburg衰弱量表、COPD评估测试问卷进行横断面调查。采用结构方程模型分析衰弱在久坐行为与生命质量之间的中介作用,Bootstrap法分析中介效应值。结果回收有效问卷219份,有效回收率为96.05%(219/228)。219例稳定期COPD患者,男168例,女51例,年龄69(62,74)岁。稳定期COPD患者久坐时间为6(5,8)h/d,衰弱得分为5(3,7)分,生命质量得分为(13.56±2.56)分。Pearson相关性分析显示,稳定期COPD患者久坐时间、衰弱与生命质量呈正相关(r=0.420、0.582,均P<0.01),且久坐时间与衰弱也呈正相关(r=0.698,P<0.01);Bootstrap法检验表明,久坐时间的直接效应为0.228(95%CI 0.082~0.374),以衰弱为中介的间接效应为0.169(95%CI 0.080~0.215),总效应为0.397,直接效应与中介效应的95%CI均不包含0,此模型为部分中介模型,中介效应占比为42.57%。结论稳定期COPD患者的生命质量处于中度水平,久坐行为不仅能够直接影响生命质量,还可以通过引起或加重衰弱,间接影响生命质量。临床工作中应鼓励患者通过站立、经常改变体位或进行轻度体力活动等方式避免因长时间久坐而引起或加重衰弱,以改善稳定期COPD患者的生命质量。

Objective To investigate the mediating role of frailty in the relationship between sedentary behavior and quality of life in patients with stable chronic obstructive pulmonary disease(COPD),so as to provide empirical evidence for improving the quality of life in COPD patients.Methods This was a cross-sectional survey.Two hundred and twenty-eight patients with stable COPD attending outpatient clinic in Chongming Branch of Shanghai Tenth People′s Hospital from January 2022 to February 2023 were selected by convenience sampling method.The General Information Questionnaire,the International Physical Activity Questionnaire,the Tilburg Frailty Indicator,and the COPD Assessment Test Questionnaire were investigated.Structural equation modeling was used to analyze the mediating role of frailty between sedentary behavior and quality of life,and Bootstrap method was used to analyze the mediating effect values.Results Finally,219 valid questionnaires were collected.The effective recovery rate was 96.05%(219/228).There were 168 males and 51 females,aged 69(62,74)years old.The sedentary time of stable COPD patients was 6(5,8)h/d,the frailty score was 5(3,7)points,and the quality of life score was(13.56±2.56)points.Pearson correlation analysis showed that the sedentary time,frailty in stable COPD were positively correlated with quality of life(r=0.420,0.582,both P<0.01),and the sedentary time was also positively correlated with frailty(r=0.698,P<0.01).Bootstrap method test results showed that the direct effect of sedentary time was 0.228(95%CI 0.082-0.374),the indirect effect mediated by frailty was 0.169(95%CI 0.080-0.215),and the total effect was 0.397,and the 95%CI of both the direct effect and the mediated effect did not contain 0.This model was partially mediated model with a 42.57%mediated effect.Conclusions The quality of life of patients with stable COPD is at an intermediate level,and sedentary behavior can not only directly affect quality of life,but also indirectly affect quality of life by causing or aggravating debilitation.In clinical work,patients should be encouraged to avoid causing or aggravating debilitation due to prolonged sedentary behavior by standing,changing position frequently or performing light physical activities to promote the improvement of quality of life in the stable phase.