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基于潜在剖面分析的儿童肝移植受者术后心理行为适应特征的异质性研究

王贝贝, 王艳, 黄明珠, 等. 基于潜在剖面分析的儿童肝移植受者术后心理行为适应特征的异质性研究[J]. 器官移植, 2023, 14(6): 838-846. doi: 10.3969/j.issn.1674-7445.2023150
引用本文: 王贝贝, 王艳, 黄明珠, 等. 基于潜在剖面分析的儿童肝移植受者术后心理行为适应特征的异质性研究[J]. 器官移植, 2023, 14(6): 838-846. doi: 10.3969/j.issn.1674-7445.2023150
Wang Beibei, Wang Yan, Huang Mingzhu, et al. Heterogeneity of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation based on latent profile analysis[J]. ORGAN TRANSPLANTATION, 2023, 14(6): 838-846. doi: 10.3969/j.issn.1674-7445.2023150
Citation: Wang Beibei, Wang Yan, Huang Mingzhu, et al. Heterogeneity of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation based on latent profile analysis[J]. ORGAN TRANSPLANTATION, 2023, 14(6): 838-846. doi: 10.3969/j.issn.1674-7445.2023150

基于潜在剖面分析的儿童肝移植受者术后心理行为适应特征的异质性研究

doi: 10.3969/j.issn.1674-7445.2023150
基金项目: 上海市自然科学基金(23ZR1438600);2023年度上海交通大学医学院护理科研重中之重项目(Jyhz2302)
详细信息
    作者简介:
    通讯作者:

    黄明珠(ORCID:0000-0001-5907-0896),副主任护师,研究方向为护理管理、移植护理,Email:huangmingzhu@renji.com

  • 中图分类号: R617,R395.1

Heterogeneity of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation based on latent profile analysis

More Information
  • 摘要:   目的   探索儿童肝移植受者心理行为适应特征的异质性亚型及不同类别儿童肝移植受者的特征差异。  方法  选取741例接受活体肝移植手术儿童受者,由其照护者填写自制一般资料调查表、世界卫生组织5项身心健康指标(WHO-5)中文版量表及长处与困难问卷(SDQ)(家长版),进行调查。以SDQ 5个维度得分为模型的外显变量,采用潜在剖面分析构建儿童肝移植受者心理行为适应特征分类模型,分析儿童肝移植受者心理行为适应特征的潜在类别,并采用单因素分析和logistic回归分析潜在类别的影响因素。  结果  儿童肝移植受者心理行为适应特征存在3个潜在类别,分别为同伴交往问题组(302例)、心理行为适应组(145例)及心理行为调节困难组(294例)。将前两组合并为心理行为健康组(447例),与心理行为调节困难组(294例)在长处与困难问卷的5个维度得分及困难总分比较差异均有统计学意义(均为P<0.001)。logistic回归分析显示,年龄≤5岁、原发病为非胆汁淤积性肝病、主干家庭类型为儿童肝移植受者心理行为调节困难的危险因素,性别为女、父母教育水平高、照护者WHO-5得分高为儿童肝移植受者术后心理行为调节困难的保护因素(均为P<0.05)。  结论  儿童肝移植受者的心理行为适应特征存在异质性,医护人员应关注不同心理行为适应类别的儿童肝移植受者的不同特征,采取针对性的筛查和干预策略,以改善儿童肝移植受者的心理行为适应结局。

     

  • 图  1  儿童肝移植受者心理行为适应特征的3个潜在类别剖面图

    Figure  1.  Three potential profiles of psychological and behavioral adaptation characteristics in children after liver transplantation

    表  1  儿童肝移植受者心理行为适应特征的潜在剖面分析模型拟合标准

    Table  1.   Model fit criteria of latent profile analysis for psychological and behavioral adaptation characteristics in children after liver transplantation

    模型 AIC BIC Entropy BLRT BLRT_P 类别概率
    1 15 514.740 15 560.820 1
    2 15 014.820 15 111.580 0.649 521.919 0.010 0.549/0.451
    3 14 921.420 15 068.870 0.696 115.398 0.010 0.408/0.196/0.396
    4 14 887.790 15 085.930 0.697 55.628 0.010 0.364/0.139/0.359/0.138
    5 14 851.960 15 100.800 0.678 57.827 0.010 0.339/0.135/0.278/0.167/0.081
    6 14 826.570 15 126.090 0.670 47.391 0.010 0.331/0.130/0.127/0.200/0.132/0.080
    下载: 导出CSV

    表  2  不同儿童肝移植受者心理行为适应特征潜在类别在SDQ各领域得分的比较($\bar {\boldsymbol{x}} $±s,分)

    Table  2.   Comparison of scores in different areas of SDQ in different latent classes of psychological and behavioral adaptation characteristics of children after liver transplantation

    组别n情绪症状品行问题多动及注意力障碍同伴交往问题亲社会行为适应困难总分
    C1组3021.8±1.31.9±1.04.3±1.72.7±1.4 6.5±1.5 10.7±2.8
    C2组1451.6±1.41.8±1.24.2±2.31.6±1.2a9.5±0.5a9.1±3.4a
    C3组2944.3±2.1a,b3.7±1.6a,b6.9±1.9a,b3.8±1.7a,b5.8±2.4a,b18.7±3.5a,b
    H−16.113−15.974−15.376−11.461−8.925−22.305
    P<0.001<0.001<0.001<0.001<0.001<0.001
      注:与C1组比较,aP< 0.05;与C2组比较,bP< 0.05。
    下载: 导出CSV

    表  3  儿童肝移植受者心理行为适应特征潜在类别的单因素分析

    Table  3.   Univariate analysis of latent classes of psychological behavior adaptation characteristics in children after liver transplantation

    变量心理行为健康组(n=447)心理行为调节困难组(n=294)χ2值/ZP
    性别[n(%)]5.5980.018
     男190(42.5)151(51.4)
     女257(57.5)143(48.6)
    年龄[n(%)]16.962<0.001
     ≤5岁274(61.3)135(45.9)
     >5岁173(38.7)159(54.1)
    是否为独生子女[n(%)]1.7650.184
     是172(38.5)99(33.7)
     否275(61.5)195(66.3)
    每日中等强度体力活动时长[n(%)]3.0390.081
     ≤30 min210(47.0)119(40.5)
     >30 min237(53.0)175(59.5)
    主要照护者[n(%)]2.7080.100
     母亲356(79.6)219(74.5)
     其他91(20.4)75(25.5)
    父母教育水平[n(%)]20.691<0.001
     高中及以下113(25.3)121(41.2)
     本科及以上334(74.7)173(58.8)
    家庭类型[n(%)]10.9930.004
     核心家庭222(49.7)111(37.8)
     主干家庭203(45.4)160(54.4)
     其他22(4.9)23(7.9)
    家庭年收入[n(%)]8.2710.082
     <30 000元94(21.0)67(22.8)
     30 000~50 000元90(21.0)67(22.8)
     50 001~100 000元97(21.7)57(19.4)
     >100 000元123(27.5)60(20.4)
     未知43(9.6)30(10.2)
    原发病[n(%)]9.6760.002
     胆汁淤积性肝病403(90.2)242(82.3)
     非胆汁淤积性肝病44(9.8)52(17.7)
    移植年龄[n(%)]1.3020.254
     ≤1岁261(58.4)184(62.6)
     >1岁186(41.6)110(37.4)
    随访时间[n(%)]0.0310.861
     ≤3年216(48.3)144(49.0)
     >3年231(51.7)150(51.0)
    免疫抑制方案[n(%)]0.3500.554
     他克莫司376(84.1)252(85.7)
     环孢素71(15.9)42(14.3)
    BMI[MP25P75),kg/m2]16(15,18)16(15,18)−0.1880.851
    照护者WHO-5得分[MP25P75),分]15(11,18)13(8,16)−4.749<0.001
    下载: 导出CSV

    表  4  儿童肝移植受者心理行为适应特征潜在类别的logistic回归分析

    Table  4.   Logistic regression analysis of latent classes of psychological behavior adaption characteristics in children after liver transplantation

    变量β标准误Wald χ2OR95%CIP
    常量0.5650.2824.0091.7590.045
    性别−0.3210.1594.0720.7250.531~0.9910.044
    年龄0.6090.16114.3501.8381.342~2.519<0.001
    父母教育水平−0.7240.16818.4680.4850.349~0.675<0.001
    家庭类型
     核心家庭10.7950.005
     主干家庭0.5200.1669.8231.6821.215~2.3280.002
     其他0.5980.3353.1781.8190.942~3.5100.075
    原发病0.5790.2346.1191.7851.128~2.8240.013
    照护者WHO-5得分−0.0740.01522.8490.9290.901~0.957<0.001
      注:①OR为比值比。
        ②CI为可信区间。
        ③−为无数据。
    下载: 导出CSV
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  • 收稿日期:  2023-07-31
  • 网络出版日期:  2023-10-07
  • 刊出日期:  2023-11-09

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