肺结核患者的自律性现状及其影响因素分析

doi:10.19982/j.issn.1000-6621.20250280

摘要/Abstract

摘要：

目的: 调查肺结核患者的自律性现状分析其影响因素,为构建肺结核患者自律行为的干预措施提供参考依据。方法: 采用便利抽样法,于2025年3—6月选取在同济大学附属上海市肺科医院结核科住院肺结核患者571例作为调查对象,使用一般资料、肺结核自律性测评量表、结核病自我效能量表、领悟社会支持量表和结核病污名感受量表进行问卷调查。结果: 纳入肺结核患者551例,肺结核患者自律性总得分为(112.40±14.71)分,相关性分析结果显示,肺结核患者自律性与结核病自我效能呈正相关(r=0.645,P<0.001),与领悟社会支持呈正相关(r=0.389,P<0.001),与结核病污名感受呈负相关(r=-0.089,P<0.05)。回归分析结果显示,女性(β=3.598, 95%CI:1.652~5.544, P<0.001)、初中/高中/中专(β=3.480, 95%CI:0.210~6.750, P=0.037)、大专及以上(β=10.016, 95%CI:6.295~13.738, P<0.001)、常住地是农村(β=-2.387, 95%CI:-4.593~-0.182, P=0.034)、结核病自我效能(β=0.792,95%CI:0.689~0.896,P<0.001)、结核病污名感受(β=0.094, 95%CI:0.017~0.171, P=0.017)是肺结核患者自律性的影响因素。结论: 肺结核患者自律性现状水平有待进一步提高,其自律性受性别、文化程度、常住地、结核病自我效能及结核病污名感受因素的影响。

关键词: 结核,肺, 自制力, 因素分析,统计学, 社会污名, 自我效能, 社会支持

Abstract:

Objective: To investigate the current status of self-discipline among pulmonary tuberculosis patients, analyze the associated influencing factors, and establish an evidence-based foundation for developing interventions about improving self-discipline behaviors in this population. Methods: Using a convenience sampling method, a total of 571 pulmonary tuberculosis patients hospitalized in the Department of Tuberculosis at Shanghai Pulmonary Hospital, Affiliated to Tongji University, from March to June 2025 were selected. Data were collected using a sociodemographic questionnaire, the Pulmonary Tuberculosis Self-Discipline Scale, the Tuberculosis Self-Efficacy Scale, the Perceived Social Support Scale, and the Perceived Tuberculosis Stigma Scale. Results: A total of 551 pulmonary tuberculosis patients were included. Their mean total self-discipline score was (112.40±14.71). Correlation analysis revealed that self-discipline was positively correlated with tuberculosis self-efficacy (r=0.645, P<0.001) and perceived social support (r=0.389, P<0.001), while negatively correlated with perceived tuberculosis stigma (r=-0.089, P<0.05). Regression analysis indicated that female (β=3.598,95%CI:1.652-5.544,P<0.001), educational attainment at junior/senior high school or technical secondary school level (β=3.480,95%CI:0.210-6.750,P=0.037), educational attainment at college level or above (β=10.016,95%CI:6.295-13.738,P<0.001), rural residence (β=-2.387,95%CI:-4.593--0.182,P=0.034), tuberculosis self-efficacy (β=0.792,95%CI:0.689-0.896,P<0.001), and perceived tuberculosis stigma (β=0.094,95%CI:0.017-0.171,P=0.017) were significant influencing factors of self-discipline in pulmonary tuberculosis patients. Conclusion: The current level of self-discipline among pulmonary tuberculosis patients requires further enhancement. Factors influencing their self-discipline include gender, educational level, place of residence, self-efficacy regarding tuberculosis, and perceived stigma associated with the disease.

Key words: Tuberculosis,pulmonary, Self-control, Factor analysis,statistical, Social stigma, Self efficacy, Social support

中图分类号:

R521

陈丽娜, 丁丽麒, 何燕, 陈丹萍. 肺结核患者的自律性现状及其影响因素分析[J]. 中国防痨杂志, 2026, 48(1): 113-120. doi: 10.19982/j.issn.1000-6621.20250280

Chen Lina, Ding Liqi, He Yan, Chen Danping. Analysis of current status of self-discipline of pulmonary tuberculosis patients and its influencing factors[J]. Chinese Journal of Antituberculosis, 2026, 48(1): 113-120. doi: 10.19982/j.issn.1000-6621.20250280

图/表 3

表1

肺结核患者自律性单因素分析

特征	例数(构成比,%)		自律性得分(分, $x ˉ$ ±s)		统计检验值		P值	事后比较
年龄组(岁)					F=13.313		<0.001	Tamhane检验
18~24¹	62(11.25)		116.19±12.65					1>4
25~35²	161(29.22)		116.22±12.57					2>3>4
36~59³	241(43.74)		111.52±14.62
≥60⁴	87(15.79)		105.08±16.89
性别					t=-5.284		<0.001
男性	344(62.43)		109.90±14.58
女性	207(37.57)		116.57±13.99
民族					t=0.778		0.437
汉族	530(96.19)		112.50±14.81
少数民族	21(3.81)		109.95±11.84
BMI(kg/m²)					F=2.623		0.050
低体质量	92(16.70)		108.91±16.22
体质量正常	341(61.89)		113.47±14.05
超体质量	104(18.87)		111.62±15.07
肥胖	14(2.54)		115.29±14.80
婚姻状况					F=10.583		<0.001	Tamhane检验
未婚¹	169(30.67)		116.66±13.20					1>2
已婚²	353(64.07)		110.53±14.52
离异/丧偶³	29(5.26)		110.41±19.85
文化程度						F=71.911	<0.001	Tamhane检验
小学及以下¹		49(8.89)		101.47±15.25				3>2>1
初中/高中/中专²		268(48.64)		107.83±14.34
大专及以上³		234(42.47)		119.93±10.99
医保类型						F=8.165	<0.001	LSD法
自费或其他¹		53(9.62)		110.53±14.22				2>3
职工基本医疗保险²		300(54.45)		114.67±14.67
城乡居民基本医疗保险³		198(35.93)		109.46±14.37
家庭月收入(元)						F=7.616	<0.001	LSD法
<3000¹		55(9.98)		107.78±15.65				4>1
3000~5999²		60(10.89)		107.25±16.16				4>3>2
6000~8999³		191(34.66)		111.76±14.22
≥9000⁴		245(44.47)		115.20±13.90
居住情况						F=6.110	<0.001	LSD法
独居¹		127(23.05)		115.98±14.37				1>2
与配偶同住²		278(50.45)		110.08±14.46				1>3
与子女同住³		45(8.17)		111.00±16.15				4>2
与父母同住⁴		101(18.33)		114.93±14.01
常住地						t=5.125	<0.001
城镇		399(72.41)		114.34±14.41
农村		152(27.59)		107.32±14.31
吸烟						t=4.295	<0.001
否		498(90.38)		113.27±14.27
是		53(9.62)		104.28±16.31
饮酒						t=3.232	0.001
否		513(93.10)		112.95±14.39
是		38(6.90)		105.03±16.99
并发基础病						t=4.940	<0.001
否		416(75.50)		114.13±14.11
是		135(24.50)		107.08±15.28
病程时间(月)						F=1.108	0.352
<1		74(13.43)		112.15±16.00
1~5		188(34.12)		113.69±13.12
6~11		131(23.77)		112.82±13.79
12~17		72(13.07)		111.67±16.11
≥18		86(15.61)		109.80±16.79
治疗类型						t=1.489	0.138
初治		433(78.58)		112.93±14.16
复治		118(21.42)		110.46±16.48

表1

表2

表3

参考文献 44

[1]	胡鑫洋, 高静韬. 世界卫生组织《2024年全球结核病报告》解读. 结核与肺部疾病杂志, 2024, 5(6): 500-504. doi:10.19983/j.issn.2096-8493.2024164.
[2]	国家卫生健康委员会办公厅. 2023年我国卫生健康事业发展统计公报[EB/OL]. (2024-8-29)[2025-02-21]. https://www.gov.cn/lianbo/bumen/202408/content_697124.htm.
[3]	林崇德, 杨治良, 黄希庭. 心理学大辞典. 上海: 上海教育出版社, 2003.
[4]	王增鑫. 居家治疗肺结核患者自律性测评量表的编制及应用研究. 济南: 山东大学, 2017.
[5]	叶江娥, 王静秋, 王舰, 等. 患者关爱与支持管理模式对结核病患者自律性和自我效能的影响. 结核与肺部疾病杂志, 2023, 4(3):216-222. doi:10.19983/j.issn.2096-8493.20230046.
[6]	顾春娥, 余淑红, 王丽, 等. 315例肺结核患者居家治疗自律性影响因素分析. 宁夏医学杂志, 2023, 45(5):471-475. doi:10.13621/j.1001-5949.2023.05.0471.
[7]	胥昕延, 郑兴敏, 郑丽丽, 等. 肺结核患者污名知觉对焦虑和抑郁的影响及自尊和孤独感的链式中介作用. 中国预防医学杂志, 2021, 22(10):766-770. doi:10.16506/j.1009-6639.2021.10.008.
[8]	Lee C, Ho C, Liao K, et al. The incidence of tuberculosis recurrence: Impacts of treatment duration of and adherence to standard anti-tuberculous therapy. J Infect Public Health, 2023, 16(11):1778-1783. doi:10.1016/j.jiph.2023.09.005.
[9]	马清艳, 侯莉莉, 党萍, 等. 耐多药肺结核的危险因素及治疗转归分析. 中国医药, 2025, 20(3):361-365. doi:10.3760/j.issn.1673-4777.2025.03.009.
[10]	Dheda K, Gumbo T, Maartens G, et al. The epidemiology,pathogenesis, transmission, diagnosis, and management of multidrug-resistant, extensively drug-resistant, and incurable tuberculosis. Lancet Respir Med, 2017, 15:S2213-S2600. doi:10.1016/S2213-2600(17)30079-6.
[11]	中华人民共和国国家卫生和计划生育委员会. WS 288—2017肺结核诊断. 结核与肺部疾病杂志, 2024, 5(4): 376-378. doi:10.19983/j.issn.2096-8493.2024022.
[12]	Green SB. How Many Subjects Does It Take To Do A Regression Analysis. Multivariate Behav Res, 1991, 26(3):499-510. doi:10.1207/s15327906mbr2603_7. pmid: 26776715
[13]	中国成人超重和肥胖预防控制指南修订委员会. 中国成人超重和肥胖症预防控制指南(2021). 北京: 人民卫生出版社, 2021.
[14]	Cao Y, Chen W, Zhang S, et al. Development And Preliminary Evaluation Of Psychometric Properties Of A Tuberculosis Self-Efficacy Scale (TBSES). Patient Prefer Adherence, 2019, 13: 1817-1827. doi:10.2147/PPA.S208336.
[15]	唐苏姚. 激励强化式营养教育对青年结核病患者自我效能、营养素养及饮食行为的应用研究. 南京:南京中医药大学, 2024. doi:10.27253/d.cnki.gnjzu.2024.000266.
[16]	Blumenthal JA, Burg MM, Barefoot J, et al. Social support,type A behavior, and coronary artery disease. Psychosom Med, 1987, 49(4):331-340. doi:10.1097/00006842-198707000-00002. pmid: 3615762
[17]	汪向东, 王希林, 马弘. 心理卫生评定量表手册(增订版). 北京: 中国心理卫生杂志社, 1999,116.
[18]	郭晓莉. 临床护士情绪智力对领悟社会支持和工作投入间中介作用. 乌鲁木齐: 石河子大学, 2020.
[19]	Van Rie A, Sengupta S, Pungrassami P, et al. Measuring stigma associated with tuberculosis and HIV/AIDS in southern Thailand: exploratory and confirmatory factor analyses of two new scales. Trop Med Int Health, 2008, 13(1):21-30. doi:10.1111/j.1365-3156.2007.01971.x. pmid: 18290998
[20]	赵爱青, 吴沛霞. 结核病污名感受量表的汉化及其信度和效度的评价. 解放军护理杂志, 2011, 28(6):12-14.
[21]	Guzmán-Torres DN, Vecino-Ortiz A I, Lucumi D. Chronic stress as a mediator of the relationship between socioeconomic status and pharmacological adherence in hypertensive patients. Biomédica, 2020, 40(2):243-256. doi:10.7705/biomedica.4780.
[22]	Chauhan A, Parmar M, Dash G C, et al. Health literacy and tuberculosis control: systematic review and meta-analysis. Bull World Health Organ, 2024, 102(6):421-431. doi:10.2471/BLT.23.290396.
[23]	Teibo TKA, Andrade RLDP, Rosa RJ, et al. Barriers That Interfere with Access to Tuberculosis Diagnosis and Treatment across Countries Globally:A Systematic Review. ACS Infect Dis, 2024, 10(8): 2600-2614. doi:10.1021/acsinfecdis.4c00466.
[24]	Malla E, Shahi S, Forsberg B. Barriers and facilitators to tuberculosis service access for patients in Bajhang,Nepal:a qualitative study based on focus groups with patients, screening camp visitors, community volunteers and medical doctors. J Health Popul Nutr, 2025, 44(1):46. doi:10.1186/s41043-025-00788-4. pmid: 39985120
[25]	朱花. 肺结核患者健康素养与遵医行为的关系及病耻感的中介效应分析. 沈阳: 沈阳医学院, 2023.
[26]	Li J, Zhang L, Zhou J, et al. Development and validation of self-management scale for tuberculosis patients. BMC Infect Dis, 2022, 22(1):502. doi:10.1186/s12879-022-07483-3. pmid: 35624424
[27]	Lei X, Huang K, Liu Q, et al. Are tuberculosis patients adherent to prescribed treatments in China? Results of a prospective cohort study. Infect Dis Poverty, 2016, 5:38. doi:10.1186/s40249-016-0134-9. pmid: 27146470
[28]	Adejumo OA, Jinabhai C, Daniel O, et al. Stigma experienced by people with drug-resistant tuberculosis in Lagos, Nigeria: a cross-sectional study. Trans R Soc Trop Med Hyg, 2025, 119(7):725-732. doi:10.1093/trstmh/traf026.
[29]	Pourali F, Khademloo M, Abedi S, et al. Relationship between smoking and tuberculosis recurrence: A systematic review and meta-analysis. Indian J Tuberc, 2023, 70(4):475-482. doi:10.1016/j.ijtb.2023.04.010. pmid: 37968054
[30]	Tesfahuneygn G, Medhin G, Legesse M. Adherence to Anti-tuberculosis treatment and treatment outcomes among tuberculosis patients in Alamata District, northeast Ethiopia. BMC Res Notes, 2015, 8: 503. doi:10.1186/s13104-015-1452-x. pmid: 26420164
[31]	何楚, 吴兆军, 彭红, 等. 江苏省结核病示范区结核病患者健康素养调查及影响因素分析. 中国防痨杂志, 2024, 46(2):190-198. doi:10.19982/j.issn.1000-6621.20230335.
[32]	刘浩. 甘肃省居民中医药健康文化素养水平及影响因素研究. 兰州: 甘肃中医药大学, 2023.
[33]	山东省卫生健康委员会. 鲁医健康说 \| 山东:基本实现普通结核诊治不出县,疑难结核治疗不出省[EB/OL].(2025-03-24)[2025-08-03]. http://wsjkw.shandong.gov.cn/zwgk/xwfb/jkzsfbh/202504/t20250427_4818224.html.
[34]	国家疾病预防控制局. 全国结核病防治规划(2024—2030年)[EB/OL].(2024-12-05)[2025-06-21]. https://www.ndcpa.gov.cn/jbkzzx/ZCWJ/common/content/content_1873899999701094400.html.
[35]	曹鑫宇, 李小麟, 薛秒, 等. 结核病患者自我效能感测评工具及影响因素的研究进展. 中国防痨杂志, 2021, 43(9):975-978. doi:10.3969/j.issn.1000-6621.2021.09.020.
[36]	徐良润, 杨明莹, 郭映武, 等. 健康信念模式下家属协同护理模式在初治涂阳肺结核患者自我管理中的应用效果. 中国防痨杂志, 2025, 47(2):210-217. doi:10.19982/j.issn.1000-6621.20240401.
[37]	Liu AK, Liu YY, Su J, et al. Self-efficacy and self-management mediate the association of health literacy and quality of life among patients with TB in Tibet, China: a cross-sectional study. Int Health, 2023, 15(5):585-600. doi:10.1093/inthealth/ihad040.
[38]	Farley H. Promoting self-efficacy in patients with chronic disease beyond traditional education: A literature review. Nurs Open, 2020, 7(1):30-41. doi:10.1002/nop2.382.
[39]	Kipp AM, Pungrassami P, Stewart PW, et al. Study of tuberculosis and AIDS stigma as barriers to tuberculosis treatment adherence using validated stigma scales. Int J Tuberc Lung Dis, 2011, 15(11): 1540-1545. doi:10.5588/ijtld.10.0273. pmid: 22008770
[40]	孟庆琳, 王云霞, 唐艳, 等. 国内外结核病患者心理支持现状分析. 中国防痨杂志, 2025, 47(8):981-985. doi:10.19982/j.issn.1000-6621.20250049.
[41]	姚蓉, 周艳, 雷丽梅, 等. 2189例住院结核病患者病耻感现状及影响因素分析. 四川医学, 2024, 45(3):239-244. doi:10.16252/j.cnki.issn1004-0501-2024.03.004.
[42]	Chen X, Du L, Wu R, et al. Tuberculosis-related stigma and its determinants in Dalian, Northeast China: a cross-sectional study. BMC Public Health, 2021, 21(1):6. doi:10.1186/s12889-020-10055-2. pmid: 33397334
[43]	王登秀, 朱千, 明杰, 等. 认知行为干预改变肺结核患者治疗依从性及心理状况的效果评价分析. 现代医药卫生, 2018, 34(19):3034-3037. doi:10.3969/j.issn.1009-5519.2018.19.028.
[44]	陈丽华, 陈桂兰, 罗宝清. 行为转变护理联合叙事护理对肺结核患者负性情绪及症状改善的影响. 中国医药指南, 2025, 23(2):171-173. doi:10.15912/j.issn.1671-8194.2025.02.051.

变量	赋值
性别	男性=0;女性=1
年龄(岁)	18~24(Z₁=0,Z₂=0,Z₃=0);25~35(Z₁=1,Z₂=0,Z₃=0);36~59(Z₁=0,Z₂=1,Z₃=0);≥60(Z₁=0,Z₂=0,Z₃=1)
婚姻状况	未婚(Z₁=0,Z₂=0);已婚(Z₁=1,Z₂=0);离异/丧偶(Z₁=0,Z₂=1)
文化程度	小学及以下(Z₁=0,Z₂=0);初中/高中/中专(Z₁=1,Z₂=0);大专及以上(Z₁=0,Z₂=1)
医保类型	自费或其他(Z₁=0,Z₂=0);职工基本医疗保险(Z₁=1,Z₂=0);城乡居民基本医疗保险(Z₁=0,Z₂=1)
家庭月总收入(元)	<3000(Z₁=0,Z₂=0,Z₃=0);3000~5999(Z₁=1,Z₂=0,Z₃=0);6000~8999(Z₁=0,Z₂=1,Z₃=0);≥9000(Z₁=0,Z₂=0,Z₃=1)
居住情况	独居(Z₁=0,Z₂=0,Z₃=0);与配偶同住(Z₁=1,Z₂=0,Z₃=0);与子女同住(Z₁=0,Z₂=1,Z₃=0);与父母同住(Z₁=0,Z₂=0,Z₃=1)
常住地	城镇=0;农村=1
吸烟	否=0;是=1
饮酒	否=0;是=1
并发基础病	否=0;是=1
结核病自我效能	原始数值录入
领悟社会支持	原始数值录入
结核病污名感受	原始数值录入

变量		β值		标准误		标准化β值		t值	P值		β的95%CI值		容差		VIF值
常量		35.080		5.226		-		6.713	<0.001		24.814~45.346		-		-
性别(参照:男性)
女性		3.598		0.991		0.119		3.633	<0.001		1.652~5.544		0.817		1.225
文化程度(参照:小学及以下)
初中/高中/中专		3.480		1.665		0.118		2.091	0.037		0.210~6.750		0.271		3.683
大专及以上		10.016		1.895		0.337		5.287	<0.001		6.295~13.738		0.214		4.667
常住地(参照:城镇)
农村	-2.387		1.123		-0.073		-2.126			0.034		-4.593~-0.182		0.746	1.340
结核病自我效能	0.792		0.053		0.551		15.051			<0.001		0.689~0.896		0.650	1.538
结核病污名感受	0.094		0.039		0.078		2.385			0.017		0.017~0.171		0.818	1.222