Construction of exercise intervention index system for patients with hyperlipidemia
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摘要:
目的 构建高脂血症患者运动干预指标体系作为量化决策工具, 辅助社区医生或运动指导人员等在制定运动处方前根据高脂血症患者需求做出精准化判断, 确定运动干预目标。 方法 基于Pubmed、Web of science、The Cochrane Library、CNKI、万方等数据库检索的运动干预高脂血症的RCT研究, 提取结局指标构建指标池, 并设计专家咨询表。2021年9月-2022年1月对16名运动人体科学、运动康复、运动医学、循证医学、内分泌或者心血管内科领域以及慢性病中医药防治学领域的部分专家实施两轮德尔菲法咨询, 进行各级指标的论证与筛选。根据专家对各指标的赋分, 运用层次分析法确立指标的权重、检验各级指标逻辑一致性, 最终形成高脂血症患者运动干预指标体系。 结果 两轮专家问卷调查的专家积极系数为100.00%、93.75%, 各项指标的权威系数分别为0.838、0.897, 协调系数分别为0.216、0.229, χ2检验P < 0.001。根据专家意见的汇总和论证, 确定4项一级指标, 24项二级指标, 55项三级指标。为方便使用, 将高脂血症患者运动干预指标体系根据评估内容制作为《一般信息调查表》《体质测量信息表》《医学检查信息表》。 结论 本研究构建的高脂血症患者运动干预指标体系结构完整、科学性强, 为社区医生或运动指导人员等给高脂血症患者制定运动处方前的系统性评估提供量化决策工具, 提升了运动干预的针对性和适用范围。 Abstract:Objective The exercise intervention index system for patients with hyperlipidemia was constructed as a quantitative decision-making tool to assist community doctors or sports instructor to make accurate judgments according to patients'needs before making exercise prescriptions and determine the goals of exercise intervention. Methods Based on Pubmed, Web of science, Cochrane Library, CNKI, Wanfang Data and other databases, the RCT studies related to exercise intervention in hyperlipidemia were retrieved.The outcome indexes were extracted to construct the index pool, and the expert consultation table was designed.From September 2021 to January 2022, two rounds of Delphi consultations were conducted on 16 experts in the fields of sports human science, sports rehabilitation, sports medicine, evidence-based medicine, endocrinology or cardiovascular medicine, and traditional Chinese medicine prevention and treatment of chronic diseases, to demonstrate and screen indexes at all levels.According to the scores of experts on each index, the analytic hierarchy process was used to establish the weight of the index and test the logical consistency of the indexes at all levels, and finally the index system of exercise intervention for patients with hyperlipidemia was formed. Results The expert positivity coefficients of the two rounds of expert's questionnaire surveys were 100.00% and 93.75%, the authoritative coefficients of each index were 0.838 and 0.882, and the coordination coefficients were 0.216 and 0.229, respectively (χ2 test P < 0.001).According to the concentration of expert opinions, 4 first-level indexes, 24 second-level indexes and 55 third-level indexes were determined.For the convenience of use, the index system of exercise intervention for patients with hyperlipidemia was made into "general information questionnaire", "physical measurement information table"and "medical examination information table" according to the evaluation content. Conclusion The exercise intervention index system for patients with hyperlipidemia was constructed complete and reliable, which provides reference for community doctors or sport instructors to make a quantitative decision-making tool before exercise prescription for hyperlipidemia patients, and improves the pertinence and application scope of exercise intervention. -
Key words:
- Hyperlipidemia /
- Index system /
- Pre-exercise assessment /
- Delphi method /
- Analytic hierarchy process
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图 1 确定运动干预目标决策流程图
Figure 1. Decision flowchart for determining exercise intervention goals
表 1 专家意见协调程度及其显著性
Table 1. The coordination degree and significance of expert opinions
轮次 指标数 CV Kendall’s W χ2值 P值 第一轮 72 0.084-0.322 0.216 245.699 ＜0.001 第二轮 83 0.072-0.302 0.229 282.239 ＜0.001 
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表 2 一级指标标准化判断矩阵
Table 2. Standardized judgment matrix for first-level indexes
一级指标 高脂血症患者
患病情况调查高脂血症患者
健康行为调查高脂血症患者
体质测试高脂血症患
者生化检查高脂血症患者患病情况调查 1 1/2 3 1/3 高脂血症患者健康行为调查 2 1 3 1/2 高脂血症患者体质测试 1/3 1/3 1 1/4 高脂血症患者生化检查 3 2 4 1
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表 3 AHP层次分析结果
Table 3. Analytic hierarchy process results
项目 特征向量 权重值 最大特征根 CI值 高脂血症患者患病情况调查 0.841 0.176 0 4.087 0.029 高脂血症患者健康行为调查 1.316 0.275 4 高脂血症患者体质测试 0.408 0.085 4 高脂血症患者生化检查 2.213 0.463 2
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表 4 一级指标权重及一致性检验结果
Table 4. First-level index weight and consistency test results
编号 指标描述 权重(wi) 组合权重 CR 1 高脂血症患者患病情况调查 0.176 0 0.176 0 0.033 2 高脂血症患者健康行为调查 0.275 4 0.275 4 3 高脂血症患者体质测试 0.085 4 0.085 4 4 高脂血症患者生化检查 0.463 2 0.463 2
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表 5 一般信息调查表
Table 5. General information questionnaire
二级指标 三级指标 年龄 - 性别 - 病史 - 家族史 - 药物或激素服用史 药物名称 每日剂量 疗程(d) 饮食行为 膳食调查表 食物频率调查问卷 身体活动(iPAQ-SF) 低/中/高等体力活动水平 其他生活习惯 饮酒习惯(mL/d) 吸烟习惯(支/d) 注：表中左列为二级指标均按权重由大到小由上至下进行排列，右列为三级指标均按权重大小从上至下排列。“-”为无三级指标。
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表 6 体质测量信息表
Table 6. Physical fitness measurement information Physical fitness measurement information sheet
二级指标 三级指标 心血管机能 安静时血压、定量负荷后(5.0METs)心率、安静时心率、最大心率 身体成分 体脂率、腹部内脏脂肪体积、身体质量指数、脂肪重量、肌肉重量、腹部皮下脂肪体积、四个皮褶(肱二头肌+肱三头肌+肩胛下肌+髂上) 体格 臀围、体重、腰围、腰臀比 心肺耐力素质 心脏功能能力(F.C.)、最大摄氧量、六分钟步行试验(6MWT) 呼吸机能 时间肺活量、肺活量 注：表中左列为二级指标均按权重由大到小由上至下进行排列，右列为三级指标均按权重大小从左至右排列。
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表 7 医学检查信息表
Table 7. Medical examination information sheet
项目 二级指标 三级指标 常用指标(必测) 血脂含量 总胆固醇(TC)、甘油三酯(TG) 血清脂蛋白 低密度脂蛋白胆固醇(LDL-C)、高密度脂蛋白胆固醇(HDL-C)、脂蛋白a 血清载脂蛋白 ApoB、ApoA1、ApoA1/ApoB、ApoE 特殊指标(选测) 脂蛋白比率 HDL-C/LDL-C(抗动脉粥样硬化指数)、TC/HDL-C(致动脉粥样硬化指数)、血脂综合指数(LCI)、LDL-C/TC、HDL-C/TC 葡萄糖耐量 OGTT、空腹血糖 氧化应激 血同型半胱氨酸(Hcy)、半胱氨酸天冬氨酸蛋白酶-3(caspase-3) 内皮功能 拮抗内皮素(ET)、一氧化氮(NO) 胰岛素 胰岛素抵抗指数、空腹胰岛素 炎症因子 超敏C反应蛋白(hs-CRP)、白细胞介素-6(IL-6) 载脂蛋白基因多态性 载脂蛋白B100(ApoB100)基因多态性 可溶性细胞黏附分子 可溶性血管细胞间黏附分子-1(sVCAM-1)、可溶性细胞间黏附分子-1(sICAM-1) 注：表中常用指标与特殊指标，都按照左列为二级指标均按权重由大到小由上至下进行排列，右列为三级指标均按权重大小从左至右排列。
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