肺癌化疗患者健康促进行为在健康信息规避与营养状况间的中介作用

余丽蓉; 彭玲聪; 张双双

doi:10.16766/j.cnki.issn.1674-4152.004302

肺癌化疗患者健康促进行为在健康信息规避与营养状况间的中介作用

doi: 10.16766/j.cnki.issn.1674-4152.004302

温州医科大学附属第一医院呼吸与危重症医学科，浙江温州 325000

基金项目:

温州市科学技术项目 Y20220634

浙江省卫生健康科技项目 2021KY1785

详细信息

通讯作者:
彭玲聪，E-mail：13867710502@163.com

中图分类号: R734.2
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出版历程
- 收稿日期: 2025-01-19
- 网络出版日期: 2026-03-13

The mediating role of health-promoting behaviors in lung cancer patients undergoing chemotherapy between health information avoidance and nutritional status

Department of Respiratory and Critical Care Medicine, the First Affiliated Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325000, China

摘要

摘要: 目的肺癌化疗患者易因恐惧回避健康信息，并间接影响营养状况。本研究旨在揭示“健康信息规避”通过抑制“健康促进行为”间接损害“营养状况”的中介机制，为临床干预提供理论依据。方法采用方便抽样法选取2020年1月—2021年12月温州医科大学附属第一医院呼吸与危重症医学科收治的158例肺癌化疗患者作为研究对象。采用Pearson相关性分析研究肺癌化疗患者主观整体营养评估工具(PG-SGA)、健康信息规避(HIA)、健康促进生活方式量表Ⅱ(HPLP-Ⅱ)评分间的相关性，采用分层回归分析法分析肺癌化疗患者营养状况的影响因素，采用SPSS Process程序中介模型Model 4分析健康促进行为(HPLP-Ⅱ评分)在健康信息规避(HIA评分)与营养状况(PG-SGA评分)间的中介作用。结果 PG-SGA评分与HIA评分呈正相关(r=0.533，P＜0.001)，与HPLP-Ⅱ评分呈负相关(r=-0.518，P＜0.001)；HPLP-Ⅱ评分与HIA评分呈负相关(r=-0.464，P＜0.001)。健康信息规避可正向预测营养状况，负向预测健康促进行为。增加中介变量健康促进行为后，健康促进行为、健康信息规避对营养状况仍有预测作用。健康促进行为在肺癌化疗健康信息规避与营养状况间的中介效应占比为29.55%。结论肺癌化疗健康信息规避既可以直接影响营养状况，又可以通过改善健康促进行为间接影响营养状况。
- 肺癌 /
- 化疗 /
- 健康促进行为 /
- 健康信息规避 /
- 营养状况 /
- 中介作用
Abstract: Objective Lung cancer patients undergoing chemotherapy often engage in health information avoidance due to fear, which may indirectly impair their nutritional status. This study aims to uncover the mediating mechanism by which health information avoidance affects nutritional status by suppressing of health-promoting behaviors, thereby providing theoretical foundations for clinical interventions. Methods From January 2020 to December 2021, 158 lung cancer patients undergoing chemotherapy in the Department of Respiratory and Critical Care Medicine of the First Affiliated Hospital of Wenzhou Medical University were selected for investigation and analysis by convenient sampling method. Pearson correlation analysis was employed to examine the correlations among patient-generated subjective global assessment tool (PG-SGA), health information avoidance (HIA), and health promoting lifestyle profile-Ⅱ (HPLP-Ⅱ) scores in lung cancer patients undergoing chemotherapy. Hierarchical regression analysis was used to identify the factors influencing nutritional status. The SPSS Process program's Mediation Model 4 was applied to analyze the mediating role of health-promoting behaviors (HPLP-Ⅱ scores) between health information avoidance (HIA scores) and nutritional status (PG-SGA scores). Results The PG-SGA score was positively correlated with the HIA score (r=0.533, P < 0.001) and negatively correlated with the HPLP-Ⅱ score (r=-0.518, P < 0.001). The HPLP-Ⅱ score was negatively correlated with the HIA score (r=-0.464, P < 0.001). Health information avoidance positively predicted nutritional status and negatively predicted health-promoting behaviors. After including health-promoting behaviors as a mediator, both health-promoting behaviors and health information avoidance remained significant predictors of nutritional status. The mediating effect of health-promoting behaviors between health information avoidance during lung cancer chemotherapy and nutritional status accounted for 29.55%. Conclusion Health information avoidance during lung cancer chemotherapy directly worsens nutritional status and also indirectly impairs nutritional outcomes by reducing engagement in health-promoting behaviors.
- Lung cancer /
- Chemotherapy /
- Health-promoting behaviors /
- Health information avoidance /
- Nutritional status /
- Mediating effect

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表 1 肺癌化疗患者PG-SGA、HIA、HPLP-Ⅱ评分情况(x±s，分)

Table 1. Scores of PG-SGA, HIA, and HPLP-Ⅱ in lung cancer patients undergoing chemotherapy (x±s, points)

项目	得分	条目均分	条目均分排序
PG-SGA	7.26±1.62	1.04±0.25
HIA
负面情绪	9.41±1.25	2.35±0.37	3
认知冲突	7.85±1.03	2.62±0.35	2
行为改变	8.68±1.44	2.89±0.41	1
总计	25.94±3.56	2.59±0.38
HPLP-Ⅱ
营养	23.07±3.15	2.56±0.28	1
运动	18.91±2.87	2.36±0.33	4
压力应对	20.02±3.04	2.50±0.31	3
人际支持	22.81±3.26	2.53±0.35	2
健康责任	20.48±3.17	2.28±0.29	6
自我实现	21.19±3.35	2.35±0.32	5
总计	126.49±23.85	2.43±0.33

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表 2 不同资料肺癌化疗患者PG-SGA评分比较(x±s，分)

Table 2. Comparison of PG-SGA scores among different data of lung cancer patients undergoing chemotherapy (x±s, points)

项目	例数	PG-SGA评分	统计量	P值
性别			1.150^a	0.252
男性	93	7.15±1.51
女性	57	7.44±1.48
年龄			0.754^a	0.452
45~55岁	38	7.09±1.58
56~65岁	112	7.32±1.64
BMI			6.352^b	0.002
＜18.5	63	7.70±1.49
18.5~24.0	51	7.21±1.56
＞24.0	36	6.56±1.58
分化程度			2.707^a	0.008
低分化	85	7.58±1.71
中高分化	65	6.84±1.59
T分期			7.055^b	0.001
Ⅱ期	41	6.58±1.52
Ⅲ期	48	7.19±1.58
Ⅳ期	61	7.77±1.61
淋巴结转移			2.792^a	0.006
有	48	7.79±1.63
无	102	7.01±1.58
化疗方案			0.126^b	0.944
紫杉醇+卡铂	63	7.22±1.61
培美曲塞+顺铂(或卡铂)	36	7.20±1.55
多西他赛+顺铂	30	7.29±1.48
依托泊苷+顺铂	21	7.44±1.63
消化系统反应
恶心呕吐			3.070^a	0.003
有	89	7.59±1.65
无	61	6.78±1.49
食欲减退			3.245^a	0.002
有	73	7.69±1.62
无	77	6.85±1.55
便秘			2.515a	0.013
有	68	7.60±1.53
无	82	6.98±1.48
腹胀腹痛			2.628^a	0.010
有	90	7.52±1.46
无	60	6.87±1.52
卡氏评分			4.345^b	0.015
70~80分	48	7.72±1.56
81~90分	68	7.21±1.49
＞90分	34	6.71±1.61
化疗次数			2.749^a	0.007
≤3次	62	7.68±1.55
＞3次	88	6.96±1.60
注：^a为t值，^b为F值。

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表 3 肺癌化疗营养状况影响因素分析(模型1)

Table 3. Analysis of factors affecting nutritional status in patients with lung cancer undergoing chemotherapy (model 1)

变量	B	SE	β	t值	P值
体重指数	-0.524	0.234	-0.515	-2.239	0.042
分化程度	-0.471	0.216	-0.453	-2.181	0.045
T分期	0.581	0.195	0.566	2.979	0.018
淋巴结转移	0.492	0.223	0.485	2.206	0.043
恶心呕吐	0.503	0.178	0.492	2.826	0.027
食欲减退	0.539	0.189	0.518	2.852	0.023
便秘	0.402	0.225	0.384	1.787	0.061
腹胀腹痛	0.423	0.239	0.399	1.770	0.068
卡氏评分	-0.388	0.261	-0.369	-1.487	0.083
化疗次数	0.454	0.215	0.424	2.112	0.047
注：R²=0.302, 调整后R²=0.288，F=10.002，P＜0.001。

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表 4 肺癌化疗营养状况影响因素分析(模型2)

Table 4. Analysis of factors affecting nutritional status in patients with lung cancer undergoing chemotherapy (model 2)

变量	B	SE	β	t值	P值
体重指数	-0.509	0.225	-0.496	-2.262	0.041
分化程度	-0.454	0.231	-0.441	-1.965	0.057
T分期	0.562	0.189	0.543	2.974	0.018
淋巴结转移	0.474	0.215	0.458	2.205	0.043
恶心呕吐	0.592	0.173	0.571	3.422	0.010
食欲减退	0.518	0.184	0.503	2.815	0.028
便秘	0.389	0.218	0.378	1.784	0.062
腹胀腹痛	0.411	0.224	0.399	1.835	0.062
卡氏评分	-0.353	0.235	-0.341	-1.502	0.081
化疗次数	0.429	0.261	0.408	1.644	0.077
HPLP-Ⅱ评分	-0.558	0.186	-0.503	-3.000	0.017
注：R²=0.497，调整后R²=0.472，F=18.006，P＜0.001。

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表 5 肺癌化疗营养状况影响因素分析(模型3)

Table 5. Analysis of factors affecting nutritional status in patients with lung cancer undergoing chemotherapy (model 3)

变量	B	SE	β	t值	P值
体重指数	-0.482	0.225	-0.467	-2.142	0.44
分化程度	-0.425	0.231	-0.408	-1.840	0.063
T分期	0.512	0.189	0.485	2.709	0.030
淋巴结转移	0.414	0.215	0.409	1.926	0.058
恶心呕吐	0.531	0.173	0.514	3.069	0.017
食欲减退	0.487	0.184	0.480	2.647	0.020
便秘	0.365	0.218	0.359	1.674	0.066
腹胀腹痛	0.379	0.224	0.368	1.692	0.065
卡氏评分	-0.325	0.235	-0.312	-1.383	0.091
化疗次数	0.406	0.261	0.389	1.556	0.079
HPLP-Ⅱ评分	-0.516	0.186	-0.503	-2.774	0.029
HIA评分	0.589	0.225	0.581	2.618	0.022
注：R²=0.699，调整后R²=0.687，F=26.238，P＜0.001。

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表 6 肺癌化疗健康促进行为在健康信息规避与营养状况间的中介效应

Table 6. Mediating effect of HPLP-Ⅱ scores between HIA scores and PG-SGA scores in lung cancer patients undergoing chemotherapy

结果变量	预测变量	拟合指标			系数显著性
结果变量	预测变量	R²	调整R²	F值		β	t值	P值
营养状况		0.341	0.337	12.648
	健康信息规避					0.372	3.698	0.005
健康促进行为		0.282	0.267	6.784
	健康信息规避					-0.186	-2.521	0.022
营养状况		0.479	0.458	20.207
	健康促进行为					-0.502	-4.003	＜0.001
	健康信息规避					0.336	3.227	0.013

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表 7 中介效应检验结果

Table 7. Results of mediation effect analysis

效应	效应值	SE	95% CI	效应值占比 (%)
总效应	0.484	0.037	0.209~1.121
直接效应：健康信息规避→营养状况	0.341	0.043	0.154~0.755	70.45
间接效应：健康信息规避→健康促进行为→营养状况	0.143	0.035	0.034~0.601	29.55

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