衰弱在老年冠心病病人久坐行为与生活质量间的中介效应分析

Analysis of the mediating effect of frailty on the relationship between sedentary behavior and quality of life in elderly patients with coronary heart disease

目的探讨老年冠心病病人久坐行为、衰弱与生活质量之间的关系。方法本研究共纳入264例上海市瑞金医院心内科门诊就诊的老年冠心病病人。采用一般资料调查表收集基本信息,采用中国成人静态行为问卷、衰弱量表、欧洲五维健康量表分别对久坐行为、衰弱和生活质量进行调查,使用Spearman相关分析久坐行为时间、衰弱与生活质量的相关性,采用SPSS宏程序PROCESS 4.1检验分析衰弱在老年冠心病病人久坐行为与生活质量关系间的中介效应,并采用Bootstrap法检验中介效应是否显著。结果老年冠心病病人久坐行为时间为6.50(4.70,8.50)h/d。264例病人中,合并衰弱58例(22.0%),衰弱前期120例(45.4%),无衰弱86例(32.6%),衰弱量表得分为1.00(0.00,2.00)分,生活质量得分为1.00(0.87,1.00)分。老年冠心病病人久坐行为时间与生活质量得分呈负相关(r=-0.596),与衰弱量表得分呈正相关(r=0.552),衰弱量表得分与生活质量得分呈负相关(r=-0.744)。久坐行为对生活质量的直接效应为-0.488,中介效应为-0.309,95%CI为(-0.381,-0.244),总效应为-0.797,中介效应占总效应的比例为38.77%。结论老年冠心病病人久坐行为时间较长,其发生衰弱的风险较高,生活质量较差。衰弱在老年冠心病病人久坐行为和生活质量关系中起部分中介作用。医护人员应关注老年冠心病病人的久坐行为时间和衰弱情况,改善老年冠心病病人的生活质量。

Objective To investigate the relationship between sedentary behavior,frailty,and quality of life in the elderly patients with coronary heart disease.Methods A total of 264 elderly patients from Cardiology Outpatient Department in Ruijin Hospital were enrolled in the study.The basic data were collected with a general information questionnaire,and the sedentary behavior,frailty,and quality of life were assessed with Chinese Adult Sedentary Behavior Questionnaire,frailty scale,and European Quality of Life-5 Dimensions(EQ-5D),respectively.Spearman correlation analysis was used to analyze the correlation between sedentary behavior,frailty and quality of life,and the mediating effect of frailty between sedentary behavior and quality of life in the elderly patients with coronary artery disease was analyzed using SPSS macro program PROCESS 4.1 test,and the Bootstrap method was used to test the significance of the mediating effect.Results The elderly patients with coronary heart disease had an average daily sedentary behavior time of 6.5(4.7,8.5)hours.Among them,58 patients(22.0%)presented with frailty,and 120 patients(45.4%)presented with pre-frailty.The score of frailty scale was 1.00(0.00,2.00),and the score of EQ-5D was 1.00(0.87,1.00).The duration of sedentary behavior was negatively correlated with the score of quality of life(r=-0.596),and positively correlated with the score of frailty scale(r=0.552),and the score of frailty scale was negatively correlated with the score of quality of life(r=-0.744).The direct effect of sedentary behavior on quality of life was-0.488,and the mediating effect was-0.309,with 95%CI of(-0.381,-0.244).The total effect was-0.797,and the proportion of the intermediate effect to the total effect was 38.77%.Conclusions Frailty plays a partial mediating role between sedentary behavior and quality of life in the elderly patients with coronary heart disease.Consequently,it is crucial to focus on both sedentary behavior and frailty to improve the quality of life of the elderly patients.