The mediating role of hope level in the relationship between family caring degree and frailty condition among maintenance hemodialysis patients
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摘要:
目的 目前关于维持性血液透析(MHD)患者希望水平、家庭关怀度、衰弱现状之间的具体关系尚缺乏报道，本研究对三者的关系进行分析，旨在减轻或延缓患者的衰弱状况。 方法 采用方便抽样法选取2023年1月—2024年6月温州医科大学附属第二医院收治的128例MHD患者进行调查。采用Pearson相关性分析、分层回归分析、多元回归分析等方法分析MHD患者希望水平在家庭关怀度与衰弱现状间的中介作用。 结果 蒂尔堡衰弱指标量表(TFI)评分与家庭关怀度指数问卷(APGAR)评分、中文版Herth希望量表(HHI)评分均呈负相关关系，HHI评分与APGAR评分呈正相关关系(P＜0.05)。年龄、跌倒史、合并基础疾病种类、APGAR评分、HHI评分进入回归方程，以上影响因素可解释MHD患者TFI评分的64.9%。家庭关怀度可负向预测衰弱现状，正向预测希望水平。增加中介变量希望水平后，家庭关怀度、希望水平对衰弱现状仍有预测作用(P＜0.05)。希望水平在MHD患者家庭关怀度与衰弱现状间存在中介作用，中介效应占比为30.90%。 结论 MHD患者衰弱现状处于较高水平，家庭关怀度可直接影响患者衰弱现状，也可通过希望水平的中介作用间接影响衰弱现状，提示应重视患者的家庭参与，以提升患者的希望水平，减轻或延缓患者衰弱状况。 Abstract:Objective The specific interrelationships among hope level, family caring degree, and frailty status in maintenance hemodialysis (MHD) patients remain understudied. The present study investigates the associations between the aforementioned factors in order to inform interventions aimed at mitigating or delaying the onset of frailty in this population. Methods From January 2023 to June 2024, MHD patients at the Second Affiliated Hospital of Wenzhou Medical University were selected by means of a convenient sampling method for the purpose of investigation and analysis. To analyze the mediating role of hope level in the relationship between family care and frailty status among MHD (Maintenance Hemodialysis) patients using Pearson correlation analysis, hierarchical regression analysis, and multiple regression analysis, the following approach can be taken. Results The Tilburg Frailty Indicator (TFI) score demonstrated a negative correlation with both the Family Adaptation, Partnership, Growth, Affection, and family APGAR index (APGAR) score and the Chinese version of the Herth Hope Index (HHI) score (all P < 0.05). Furthemore, a positive correlation was observed between the HHI score and the APGAR score (P < 0.05).The regression equation was constructed with the following variables: age, fall history, type of underlying disease, APGAR score, and HHI score. The regression equation, explained 64.9% of the TFI score of MHD patients. The findings of this study indicate that a family caring degree may serve as a predictor of both frailty status and hope level, with a statistical significance of P < 0.05. Following an increase in the hope level of the intermediate variable, the family caring degree and the hope level maintained a predictive effect on the frailty status. The present study hypothesized that hope level would have a mediating effect between family caring degree and debilitation status of MHD patients, and that this effect would account for 30.90% of the variance. Conclusion The frailty status of MHD patients is elevated, and the degree of frailty condition can directly affect the frailty status of patients, or indirectly affect the frailty status through the mediating role of hope level. This suggests that family participation of patients should be given consideration in order to improve the hope level of patients and reduce or delay the frailty status of patients. -
Key words:
- Maintenance hemodialysis /
- Family caring degree /
- Weak status quo /
- Hope level /
- Mediating effect
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表 1 128例MHD患者TFI、HHI、APGAR评分
Table 1. TFI, HHI, and APGAR scores of 128 MHD patients
项目 得分x±s，分) 分级 例数(%) TFI 躯体衰弱(8个条目) 2.34±0.52 衰弱 54(42.19) 心理衰弱(4个条目) 1.29±0.42 无衰弱 74(57.81) 社会衰弱(3个条目) 1.06±0.27 总计(15个条目) 4.70±0.68 HHI 对现实与未来的积极态度(4个条目) 10.35±1.67 低希望水平 12(9.38) 采取积极的行动(4个条目) 12.34±1.45 中等希望水平 68(53.13) 与他人保持亲密的关系(4个条目) 10.61±1.82 高希望水平 48(37.50) 总计(12个条目) 33.30±3.89 APGAR(5个条目) 5.85±1.21 严重家庭功能障碍 15(11.72) 中度家庭功能障碍 50(39.06) 家庭功能良好 63(49.22) 
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表 2 不同资料MHD患者TFI评分比较(x±s，分)
Table 2. Comparison of TFI scores of different MHD patients (x±s, points)
项目 例数(n=128) TFI评分 统计量 P值 年龄 7.161a ＜0.001 ＜60岁 50 4.29±0.62 ≥60岁 78 4.96±0.70 性别 1.003a 0.318 男性 71 4.62±0.69 女性 57 4.74±0.65 BMI 0.183b 0.833 ＜18.5 39 4.65±0.72 18.5~24.0 68 4.71±0.69 ＞24.0 21 4.76±0.70 吸烟 0.527a 0.599 是 40 4.75±0.71 否 88 4.68±0.69 饮酒 0.476a 0.635 是 43 4.74±0.70 否 85 4.68±0.66 存在抑郁情绪 6.357a ＜0.001 是 51 5.18±0.75 否 77 4.38±0.66 跌倒史 7.149a ＜0.001 是 25 5.58±0.74 否 103 4.49±0.67 能独立行走 4.418a ＜0.001 是 107 4.58±0.70 否 21 5.31±0.65 主要照顾者 0.157b 0.854 配偶 80 4.68±0.69 子女或子女配偶 40 4.75±0.71 其他 8 4.65±0.67 患者月收入 0.176b 0.839 ＜3 000元 38 4.70±0.70 3 000~5 000元 60 4.73±0.68 ＞5 000元 30 4.64±0.65 医保 0.853a 0.395 新农合 83 4.74±0.71 城镇医保或职工医保 45 4.63±0.67 合并基础疾病种类 19.541b ＜0.001 0种 28 4.12±0.72 1~2种 59 4.65±0.69 ＞2种 41 5.17±0.67 原发疾病 0.108b 0.956 慢性肾小球肾炎 48 4.69±0.70 高血压肾病 32 4.65±0.75 糖尿病肾病 27 4.73±0.66 狼疮性肾炎 21 4.75±0.71 透析龄 0.890a 0.375 ＜1年 68 4.65±0.73 ≥1年 60 4.76±0.66 并发症 5.155a ＜0.001 有 41 5.02±0.75 无 87 4.34±0.67 HHI评分 13.066b ＜0.001 低水平 12 5.31±0.64 中等水平 68 4.85±0.70 高水平 48 4.34±0.67 APGAR评分 10.605b ＜0.001 严重家庭功能障碍 15 5.30±0.61 中度家庭功能障碍 50 4.83±0.68 家庭功能良好 63 4.45±0.72 注：a为t值，b为F值。
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表 3 MHD患者衰弱现状的影响因素分析
Table 3. Influencing factors of frailty status of MHD patients
变量 β SE β′ t值 P值 模型1 年龄 0.445 0.162 0.439 2.747 0.030 存在抑郁情绪 0.432 0.167 0.424 2.587 0.037 跌倒史 0.473 0.160 0.467 2.956 0.024 能独立行走 -0.392 0.195 -0.388 2.010 0.048 合并基础疾病种类 0.537 0.151 0.513 3.556 0.011 并发症 0.414 0.184 0.408 2.250 0.043 模型2 年龄 0.430 0.149 0.415 2.886 0.028 存在抑郁情绪 0.409 0.173 0.394 2.364 0.040 跌倒史 0.451 0.152 0.425 2.967 0.022 能独立行走 -0.378 0.202 -0.361 -1.871 0.064 合并基础疾病种类 0.529 0.168 0.507 3.149 0.017 并发症 0.411 0.215 0.408 1.912 0.058 HHI评分 -0.552 0.164 -0.529 -3.366 0.009 模型3 年龄 0.418 0.142 0.389 2.944 0.026 存在抑郁情绪 0.397 0.209 0.387 1.900 0.064 跌倒史 0.428 0.143 0.412 2.993 0.020 能独立行走 -0.359 0.224 -0.331 -1.603 0.091 合并基础疾病种类 0.508 0.181 0.476 2.807 0.033 并发症 0.402 0.226 0.392 1.779 0.075 HHI评分 -0.513 0.152 -0.498 -3.375 0.008 APGAR评分 -0.548 0.132 -0.519 -4.152 ＜0.001 注：模型1，R2=0.227，调整后R2=0.214，F=9.868，P＜0.001；模型2，R2=0.473，调整后R2=0.429，F=18.004，P＜0.001；模型3，R2=0.688，调整后R2=0.649，F=29.216，P＜0.001。
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表 4 MHD患者希望水平在家庭关怀度与衰弱现状间的中介效应
Table 4. Mediating effect of hope level between family caring degree and faltering status of MHD patients
结果变量 预测变量 拟合指标 系数显著性 R2 调整R2 F值 β t值 P值 衰弱现状 0.329 0.316 17.254 家庭关怀度 -0.319 4.103 ＜0.001 希望水平 0.212 0.204 6.003 家庭关怀度 0.075 -2.224 0.039 衰弱现状 0.420 0.403 21.015 希望水平 -0.518 -4.368 ＜0.001 家庭关怀度 -0.250 3.267 0.005
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表 5 中介效应检验结果
Table 5. Results of mediation effect test
效应 效应值 SE 95% CI 效应值占比(%) 总效应 0.479 0.048 0.215~1.067 直接效应：家庭关怀度→衰弱现状 0.331 0.042 0.164~0.668 69.10 间接效应：家庭关怀度→希望水平→衰弱现状 0.148 0.029 0.052~0.421 30.90
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