中青年心力衰竭患者同期症状网络分析

Network Analysis of Contemporaneous Symptoms in Middle-aged and Young Patients with Heart Failure

目的调查中青年心力衰竭(heart failure,HF)患者症状的发生率和严重程度,构建中青年HF患者症状网络并分析网络中心化指标,探索症状网络中的核心症状,挖掘症状干预的靶点。方法便利抽样法选取973例中青年HF患者为研究对象,采用中文版Memorial心力衰竭症状评估量表调查患者症状的发生率和严重程度,使用正则化偏相关网络分析来构建症状网络,探索症状网络中心性指标。结果中青年HF患者最常见的症状是胸痛(75.8%),最严重的症状是没劲/没精神,症状网络中,缺乏食欲(r S=13.90,r C=0.0129)是强度中心性值和紧密中心性值最大的症状,哀伤(59.4%)有较高的可预测性。结论以缺乏食欲为核心进行干预可高效减低整个网络的严重程度,早期干预没劲/没精神症状可以减轻患者症状管理负担,识别可预测性较强的症状有助于症状管理靶点的选择。医护人员可以结合上述症状规律,对HF患者实施科学、精准的症状管理。

Objective To investigate the incidence and severity of symptoms in middle-aged and young patients with heart failure(HF),construct a symptom network for these patients,analyze its central indices,and to explore core symptoms and targets for symptom intervention.Methods A total of 973 middle-aged and young patients with HF were selected to investigate the incidence and severity of symptoms using the Chinese version of the Memorial Heart Failure Symptom Assessment Scale.A regularized partial correlation network analysis was used to construct a symptom network and explore its central indices.Results The most common symptom of young and middle-aged patients with chronic heart failure was chest pain(75.8%),and the most serious symptom was lethality/inactivity.The network showed lack of appetite(r S=13.90,r C=0.0129)was the most obvious symptom in strength and closeness among central indices.Sadness(59.4%)was more predictable.Conclusions Intervention on lack of appetite can effectively reduce the severity of the entire network.Early intervention in lethality/inactivity can alleviate the symptoms.Identifying symptoms with strong predictability helps in selecting targets for intervention.Medical staff should implement scientific and accurate symptom management for patients with HF.