肝硬化症状特征的潜在类别分析和影响因素

肝脏 ›› 2024, Vol. 29 ›› Issue (3): 273-277.

肝硬化症状特征的潜在类别分析和影响因素

张淑华, 蒋萍梅, 蔡晓兰, 曹竹君, 钱珠萍

200025 上海交通大学医学院附属瑞金医院护理部(张淑华,蒋萍梅,蔡晓兰, 钱珠萍),感染科(曹竹君)

收稿日期:2023-11-19 出版日期:2024-03-31 发布日期:2024-05-16
通讯作者: 钱珠萍, Email: gelico@126.com
基金资助:
上海市促进市级医院临床技能与临床创新三年行动计划(SHDC2022CRS002A);上海公共卫生三年行动计划(GWV-10.1-XK13);上海市临床重点专科(感染病学)(shslczdzk01103)

An analysis on the latent classification and influencing factors of the characteristic symptoms in liver cirrhotic patients

ZHANG Shu-hua¹, JIANG Ping-mei¹, CAI Xiao-lan¹, CAO Zhu-jun², QIAN Zhu-ping¹

1. Department of Nursing, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China;
2. Department of Infection Disease, Ruijin Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China

Received:2023-11-19 Online:2024-03-31 Published:2024-05-16
Contact: QIAN Zhu-ping, Email: gelico@126.com

摘要/Abstract

摘要： 目的探讨不同肝硬化症状特征患者的人口学和疾病特征,及其分类的影响因素。方法采用便利抽样法,选取2020年6月至2021年6月上海市瑞金医院感染科住院肝硬化患者220例,采用一般资料调查表、Memorial症状评估量表进行调查。对肝硬化症状特征进行潜在类别分析,logistic多元回归分析分类的影响因素。结果肝硬化症状特征分为症状高发组144例(65.45%)和低疲乏-无肿胀组76例(34.55%)2个潜在类别;相较低疲乏-无肿胀组,症状高发组合并肝脏肿瘤(28.95%比45.83%)、低蛋白血症(56.58%比70.83%)和营养风险(39.47%比60.42%)的比例更高,中大量腹水(14.47%比34.02%)和Child-pugh分级B+C级(57.89%比69.44%)更高,日常生活活动能力(99.87%比96.88%)则较低(P<0.05)。合并肝脏肿瘤(OR=0.526,P<0.05)和腹水量增大(OR=1.612,P<0.01)是影响肝硬化症状分类的主要因素。结论肝硬化症状特征存在异质性,可分为2个潜在类别,应加强关注合并肝脏肿瘤、肝功能严重损伤、低蛋白血症、营养状况不良和中大量腹水的患者。

关键词: 肝硬化, 症状, 潜在类别分析

Abstract: Objective To classify the symptomatic characteristics of patients with liver cirrhosis, and to explore the demographic differences and disease characteristics in patients with different symptomatic categories. Methods A total of 220 liver cirrhotic patients in the department of infectious disease of a tertiary hospital in Shanghai from June 2020 to June 2021 were selected as the research subjects by using convenient sampling method. The general information questionnaire and memorial symptom assessment scale were used for investigating the patients. Latent classification analysis were used to classify the liver cirrhotic patients according to their symptoms. Multivariate logistic regression was used to explore the differences in demographics and disease’ characteristics of patients with different categories. Results According to symptom characteristics, patients with liver cirrhosis were divided into 2 potential categories, "symptoms high incident group" (65.45%) and "low fatigue and non-bloated group" (34.55%). Compared with the "low fatigue and non-bloated group", there were higher rates of liver tumor (28.95%/45.83%), hypoproteinemia (56.58%/70.83%), nutritional risk (39.47%/60.42%), and higher levels of ascites volume (14.47%/34.02%) and Child-Pugh grade (B+C 57.89%/69.44%), and lower ability of daily living activities (99.87/96.88) in the "symptoms high incident group" (P<0.05). Complicated with liver tumors (OR=0.526, P<0.05) and increased volume of ascites (OR=1.612, P<0.01) were the main influencing factors associated with the classifications of symptomatic characteristics in liver cirrhotic patients. Conclusion The symptomatic characteristics of liver cirrhosis are heterogeneous and can be divided into 2 latent classes. More attention should be paid to the patients complicated with liver tumor, liver function damage, hypoproteinemia, malnutrition and larger volume of ascites. The symptoms should be managed through early recognition and precise intervention.

Key words: Liver cirrhosis, Characteristic symptoms, Classification

张淑华, 蒋萍梅, 蔡晓兰, 曹竹君, 钱珠萍. 肝硬化症状特征的潜在类别分析和影响因素[J]. 肝脏, 2024, 29(3): 273-277.

ZHANG Shu-hua, JIANG Ping-mei, CAI Xiao-lan, CAO Zhu-jun, QIAN Zhu-ping. An analysis on the latent classification and influencing factors of the characteristic symptoms in liver cirrhotic patients[J]. Chinese Hepatolgy, 2024, 29(3): 273-277.

参考文献

[1] Yoshiji H, Nagoshi S, Akahane T, et al. Evidence-based clinical practice guidelines for Liver Cirrhosis 2020[J]. J Gastroenterol, 2021, 56(7): 593-619.
[2] Lenz ER, Pugh LC, Milligan RA, et al. The middle range theory of unpleasent symptoms: An update[J]. ANS Adv Nursing Sci, 1997, 19(3): 14-27.
[3] Miaskowski C, Barsevick A, Berger A, et al. Advancing symptom science through symptom cluster research: expert panel proceedings and recommendations[J]. J Natl Cancer Inst, 2017, 109(4).
[4] 邱皓政. 潜在类别模型的原理与技术[M]. 北京: 教育科学出版社, 2008.
[5] 中华医学会肝病学分会. 肝硬化诊治指南[J]. 实用肝脏病杂志, 2019, 22(6): 770-786.
[6] 苏蒙召, 吴远珏, 李玲, 等. NRS2002与RFH-NPT在肝硬化患者中应用比较:基于SGA标准[J]. 临床消化病杂志, 2022, 34(1): 1-6.
[7] 侯东哲, 张颖, 巫嘉陵,等. 中文版Barthel指数的信度与效度研究[J]. 临床荟萃, 2012, 27(3): 219-221.
[8] Portenoy RK, Thaler HT, Kornblith AB, et al. The memorial symptom assessment scale:an instrument for the evaluation of symptom prevalence,characteristics,and distress.[J]. Eur J Cancer, 1994, 30A(9): 1326-1336.
[9] Cheng KK, Wong EM, Ling WM, et al. Measuring the symptom experience of Chinese cancer patients: a validation of the Chinese version of the memorial symptom assessment scale[J]. J Pain Symptom Manage, 2009, 37(1): 44-57.
[10] Miaskowski C, Dunn L, Ritchie C, et al. Latent class analysis reveals distinct subgroups of patients based on symptom occurrence and demographic and clinical characteristics[J]. J Pain Symptom Manage, 2015, 50(1): 28-37.
[11] Nouri-Vaskeh M, Afshan H, Malek Mahdavi A, et al. Curcumin ameliorates health-related quality of life in patients with liver cirrhosis: a randomized, double-blind placebo-controlled trial[J]. Complement Ther Med, 2020, 49: 102351.
[12] Enezi A, Al-Jahdali F, Ahmed AE, et al. Symptoms of daytime sleepiness and sleep apnea in liver cirrhosis patients[J]. Ann Hepatol, 2017, 16(4): 591-598.
[13] 李毅, 刘艳, 许永攀, 等. 基于聚类分析和Logistic回归分析的乙肝后肝硬化症状组合规律研究[J]. 辽宁中医药大学学报, 2017, 19(9): 164-167.
[14] 李延龙, 王天芳, 吴秀艳, 等. 800例肝炎肝硬化患者不同Child-Pugh分级的症状分布研究[J]. 成都中医药大学学报, 2018, 41(1): 42-45.
[15] Ebadi M, Bhanji RA, Mazurak VC, et al. Sarcopenia in cirrhosis: from pathogenesis to interventions[J]. J Gastroenterol, 2019, 54(10): 845-859.
[16] 熊万银, 高莉. 营养支持小组在肝硬化病人营养管理中的应用效果分析[J]. 全科护理, 2022, 20(5): 619-621.
[17] Garman KS, Cohen HJ. Functional status and the elderly cancer patient[J]. Crit Rev Oncol Hematol, 2002, 43(3): 191-208.
[18] 应金萍, 蔡根莲, 潘梦燕, 等. 维持性血液透析患者衰弱表型对日常生活活动能力的影响[J]. 中华肾脏病杂志, 2021, 37(8): 639-646.
[19] 中华人民共和国卫健委. 原发性肝癌诊疗规范(2019年版)[J]. 中国实用外科杂志, 2020, 40(2): 121-138.
[20] 马鸿琦, 肖向敏, 郭雅博, 等. 原发性肝癌患者围手术期症状群及相关因素研究[J]. 护理学杂志, 2018, 33(4): 19-23.
[21] 李玉玲. 多学科协作护理模式对肝硬化腹水患者生活质量、肝功能及营养状况的影响[J]. 黑龙江医学, 2020, 44(6): 850-852.
[22] 中华医学会肝病学分会. 肝硬化腹水及相关并发症的诊疗指南[J]. 临床肝胆病杂志, 2017, 33(10): 1847-1863.