围腹膜透析期患者积极度的纵向变化特征及影响因素研究 [中文引用][英文引用]

目的  追踪围腹膜透析期患者积极度的纵向变化特征，探讨其群体异质性并分析影响因素，为制定促进围腹膜透析期患者积极度的干预策略提供科学依据。方法  采用前瞻性纵向研究设计，便利抽取 2022 年 5 月至 2025 年 3 月广东省 3 家三级甲等综合医院肾病病房拟行腹膜透析治疗的 355 例终末期肾病患者为研究对象。采用患者积极度量表（patientactivation measure-13，PAM-13）纵向评估患者积极度得分，简易疾病感知问卷（the brief illness perception questionnaire，BIPQ）评估患者疾病感知得分，患者健康问卷 -2（patient health questionnaire-2，PHQ-2）评估患者抑郁状态。依据桑基图刻画积极度纵向变化特征并划分亚组，采用线性混合效应模型识别围腹膜透析期患者积极度的影响因素。结果  347 例患者完成研究。围腹膜透析期患者积极度得分总体呈上升趋势（P<0.001），但纵向变化呈现群体异质性，其中提升组 251 例（72.33%），稳定组 50 例（14.41%），持续低水平或下降组 46 例（13.26%）。多因素分析结果显示，较高学历、较高的血红蛋白水平、急性左心衰病史是患者积极度提升的促进因素，高龄与抑郁是阻碍因素。亚组分析进一步显示，大专及以上学历、较高的估算肾小球滤过率（estimated glomerular filtration rate，eGFR）是患者积极度提升的促进因素；高龄与负性疾病感知是积极度提升的阻碍因素。结论  围腹膜透析期患者接受透析治疗后积极度得分随时间推移而上升，而且其纵向变化存在异质性。负性疾病感知与抑郁是影响患者围腹膜透析期积极度的重要可干预因素。临床医护人员应打破同质化常规护理，动态评估积极度异质性变化特征并及早实施个体化干预。

Objective To explore the longitudinal change patterns of patient activation during the transition to peritoneal dialysis in patients with end-stage renal disease，and to explore the group heterogeneity and influencing factors，thereby providing a scientific basis for making interventions for promoting patient activation. Methods A prospective longitudinal study design and a convenience sampling method were used. Patients with end-stage renal disease scheduled for peritoneal dialysis were selected from the nephrology wards in three Tier-IIIA hospitals in Guangdong between May 2022 and March 2025. The patient activation measure-13 （PAM-13）was used to track longitudinal patient activation scores. The brief illness perception questionnaire（BIPQ）was used to measure illness perception scores. The patient health questionnaire-2（PHQ-2）was used to assess depression status. A Sankey diagram was used to portray longitudinal change characteristics and divide subgroups. A linear mixed-effects model（LMM）was applied to identify the influencing factors of patient activation. Results A total of 347 patients completed the follow-up. The activation scores of patients during the transition to peritoneal dialysis generally showed a significant upward trend（P<0.001）with a population heterogeneity. Three subgroups were identified: improved group（n=251，72.33%），stable group（n=50，14.41%）and persistent low-level or declined group （n=46，13.26%）. Multivariate analysis showed that higher education and higher serum haemoglobin were independent positive factors influencing the patient activation in the total study population. Older age and depression were independent negative influencing factors. Subgroup analysis further revealed a college degree or above，a higher estimated glomerular filtration rate（eGFR）were a positive factor promoting activation growth in the improved group. Older age and negative illness perception were the core negative factors leading to persistent low-level or declining activation. Conclusion Patient activation generally improves over time during the transition to peritoneal dialysis，but it exhibits significant dynamic changes of heterogeneity. Early illness perception and depression status of the patients were profound for intervention throughout this period. Clinical staff should avoid homogeneous routine education，dynamically evaluate the heterogeneous change patterns of patient activation，and implement individualised interventions early.