阴虚质与抑郁在缺血性脑卒中患者久坐行为与衰弱间的链式中介效应 [中文引用][英文引用]

目的  探讨阴虚质与抑郁在缺血性脑卒中患者久坐行为与衰弱之间的链式中介效应，为临床制订干预措施提供参考依据。方法  于 2023 年 10 月— 2024 年 2 月采用便利抽样法，选取西安市某三级甲等中医医院 489 例缺血性脑卒中患者作为研究对象，采用一般资料调查表、中文版 Tilburg 问卷（Tilburg frailty indicator，TFI）、国际体力活动短问卷（internationalphysical activity questionnaire，IPAQ）、中医体质量表（constitution in Chinese medicine questionnaire，CCMQ）中的阴虚质亚量表、健康问卷抑郁量表（patient health questionnaire-9，PHQ-9）进行调查。采用 Pearson 相关分析或 Spearman 相关分析缺血性脑卒中患者久坐行为、阴虚质、抑郁、衰弱之间的相关性；采用插件 Process3.5 宏程序 Model 6 进行链式中介效应检验与 Bootstrap 判定中介效应的显著性。结果  445 例患者完成研究。缺血性脑卒中患者衰弱得分 9.0（5.5，12.5）分，衰弱患病率 75.1%（334/445）；平均每日久坐时间（10.1±1.5）h，阴虚质得分（24.0±5.7）分，抑郁得分 9.0（7.0，10.0）分。相关分析结果显示，缺血性脑卒中患者久坐行为、阴虚质、抑郁、衰弱两两呈正相关（均 P<0.01）。中介效应分析结果显示，久坐行为对缺血性脑卒中患者衰弱存在直接效应（β=0.457，95%CI：0.172~0.743），效应量为 49.2%；阴虚质与抑郁在久坐行为和衰弱之间分别存在间接中介效应（β=0.294，95%CI：0.147~0.470；β=0.123，95%CI：0.025~0.244），效应量分别为 31.7% 和 13.3%；阴虚质 - 抑郁的链式中介效应显著（β=0.054，95%CI：0.012~0.104），效应量为 5.8%；总间接效应为 0.471，占总效应 50.8%。结论  阴虚质与抑郁情绪在缺血性脑卒中患者久坐行为与衰弱之间呈链式中介效应。建议缺血性脑卒中患者应积极减少久坐行为，增加适度身体活动，以促进体质改善、缓解抑郁情绪，从而有效降低衰弱风险，提升患者整体康复效果。

Objective To explore the chain mediating effects of Yin-deficiency and depression between sedentary behaviours and frailty in patients with ischemic stroke，and to provide guidelines for intervention. Methods Between October，2023 and February， 2024，489 inpatients with ischemic stroke in a Tier-IIIA hospital of traditional Chinese medicine in Xi’an were recruited to participate the study. A general information questionnaire，international physical activity questionnaire（IPAQ）and Tilburg frailty indicator（TFI）， constitution in Chinese medicine questionnaire（CCMQ），patient health questionnaire-9（PHQ-9）were employed for data collection. Pearson or Spearman correlation analysis was used to explore the correlations of Yin-deficiency constitution and depression with sedentary behaviours and frailty. Percentile Bootstrap method with deviation correction（process 3.5 plug-in）was used to test the chain mediation effect. Results Among the 480 participants，445 completed the investigation. The frailty score was 9.0（between 5.5 and 12.5）and the average daily sedentary time was 10.1±1.5 hours. Yin-deficiency constitution score was 24.0±5.7，and depression score was 9.0（between 7.0 and 10.0）. Sedentary behaviours，Yin-deficiency，depression and frailty were positively correlated（all P<0.01）. Intermediary analysis showed that the direct effect of sedentary behaviours on frailty was significant（β=0.457，95%CI：0.172-0.743）， accounting for 49.2% of the effect. Yin-deficiency constitution and depression had a significant indirect mediating effect between sedentary behaviours and frailty（β=0.294，95%CI：0.147-0.470；β=0.123，95%CI：0.025-0.244），accounting for 31.7% and 13.3% per effect，respectively. The chain mediating effect of Yin-deficiency constitution depression was significant（β=0.054，95%CI：0.012- 0.104），accounting for 5.8% of the effect. The total indirect effect was 0.471，accounting for 50.8% of the total effect. Conclusion Yindeficiency constitution and depression play a chain mediating role between sedentary behaviours and frailty in patients with ischemic stroke. Patients with ischemic stroke should actively minimise sedentary behaviours and take more physical activity to enhance constitution and relieve depression，thus effectively reducing the risk of frailty and improving the overall rehabilitation effect.