经皮冠状动脉介入术后患者恐惧疾病进展的潜在剖面分析及影响因素研究

Latent profile analysis of patients′fear of progression after percutaneous coronary intervention

目的基于潜在剖面分析方法识别经皮冠状动脉介入术(PCI)后患者恐惧疾病进展的分型,探讨不同分型的影响因素。方法采用横断面调查法,以便利抽样法选取2023年4—12月在安徽省公共卫生临床中心住院行PCI术后的冠心病患者为研究对象,采用一般资料调查问卷、恐惧疾病进展简化量表、反刍思维量表、简易版疾病感知问卷对其进行调查。采用Mplus 8.3软件构建潜在剖面模型。结果共纳入资料完整的患者240例,男176例,女64例,年龄28~84(62.94±11.20)岁。潜在剖面分析结果显示,PCI术后患者恐惧疾病进展特征可分为3个潜在类别:低恐惧组(59例占24.6%)、中等恐惧组(111例占46.3%)、高恐惧-担心家庭工作组(70例占29.1%)。多元Logistic回归分析结果显示,受教育程度[中等恐惧组与低恐惧组相比,小学及以下OR(95%CI)为4.054(1.370~11.996)、中学/中专OR(95%CI)为3.096(1.104~8.682),均P<0.05;高恐惧-担心家庭工作组与低恐惧组相比,小学及以下OR(95%CI)为5.996(1.562~23.014),P<0.05]、居住地[中等恐惧组和高恐惧-担心家庭工作组分别与低恐惧组相比的OR(95%CI)为2.587(1.187~5.637)、6.958(2.567~18.856),均P<0.05]、介入治疗次数[中等恐惧组和高恐惧-担心家庭工作组分别与低恐惧组相比,OR(95%CI)为2.496(1.107~5.630)、4.924(1.809~13.402),均P<0.05]、反刍思维[高恐惧-担心家庭工作组与低恐惧组相比,OR(95%CI)为1.130(1.055~1.210),P<0.05]和疾病感知[中等恐惧组和高恐惧-担心家庭工作组分别与低恐惧组比较,OR(95%CI)为1.181(1.046~1.334)、1.349(1.164~1.562),均P<0.05]是PCI术后患者恐惧疾病进展的影响因素。结论PCI术后患者恐惧疾病进展水平存在明显的异质性,医护人员可根据患者恐惧疾病进展的潜在类别特征实施精准干预,以降低恐惧疾病进展水平。

Objective To identify the types of fear of progression in patients after percutaneous coronary intervention(PCI)based on latent profile analysis,and to explore the influencing factors of different types.Methods Cross-sectional survey method was used to select the patients with coronary heart disease and underwent PCI in Anhui Public Health Clinical Center from April to December 2023 as the research object.The general information questionnaire,Fear of Progression Questionnaire-Short Form,Ruminative Response Scale and Brief Illness Perception Questionnaire were used to investigate them.Mplus8.3 software was used to construct the latent profile model.Results A total of 240 patients with complete data were enrolled,including 176 males and 64 females,aged 28-84(62.94±11.20)years.The results of latent profile analysis showed that the fear of progression of patients after PCI could be divided into three latent categories:There were 59 cases(24.6%)in the low fear group,111 cases(46.3%)in the medium fear group,and 70 cases(29.1%)in the high fear-worried family group.The results of multiple logistic regression analysis showed that compared with the low fear group,the probability of having primary school education or below was higher in the medium fear group(OR=4.054,95%CI 1.370-11.996)and the high fear-worry family group(OR=5.996,95%CI 1.562-23.014),secondary school was more likely in the moderate fear group(OR=3.096,95%CI 1.104-8.682,all P<0.05);Living in rural areas were more likely to be in the moderate fear group(OR=2.587,95%CI 1.187-5.637)and the high few-worry family group(OR=6.958,95%CI 2.567-18.856,all P<0.05);The probability of the first interventional therapy was higher in the moderate fear group(OR=2.496,95%CI 1.107-5.630)and the high fear-worry family group(OR=4.924,95%CI=1.809-13.402,all P<0.05).In addition,compared with the low fear group,patients with higher rumination were more likely to belong to the high few-worry family working group(OR=1.130,95%CI 1.055-1.210,P<0.05);Moderate fear group(OR=1.181,95%CI 1.046-1.334)and high fear family working group(OR=1.349,95%CI 1.164-1.562,all P<0.05)had a higher level of illness perception.Conclusions There is significant heterogeneity in the fear of progression among patients after PCI.Medical staff can implement precise intervention according to the potential category characteristics of patients′fear of progression,so as to reduce the level of fear of disease progression.