初治肺结核患者延续治疗期自我管理潜在剖面分析及护理策略

doi:10.19982/j.issn.1000-6621.20260080

摘要/Abstract

摘要：

目的: 探讨延续治疗期肺结核患者自我管理行为的潜在类别特征,分析不同潜在类别的影响因素,为制定个体化院外干预策略提供参考。方法: 采用便利抽样法,选取2025年6—12月在郑州市第六人民医院完成初始治疗后转入居家延续治疗期并接受随访的肺结核患者403例作为研究对象。采用一般资料调查表、结核病患者自我管理量表、居家治疗肺结核患者护理需求调查表进行问卷调查,运用Mplus 8.3软件进行潜在剖面分析。结果: 初治肺结核患者延续治疗期自我管理行为可分为3个潜在类别:低认知-低意愿-中强行为组(24例,6.0%)、低认知-中等意愿-弱行为组(85例,21.0%)和高自我管理组(294例,73.0%)。多元logistic回归分析显示,以高自我管理组作为参照组,低认知-低意愿-中强行为组独立相关因素为:无稳定职业(OR=14.737,95%CI:2.995~72.501)、治疗时长<3个月(OR=8.914,95%CI: 2.081~38.179)、治疗时长为3~6个月(OR=7.352,95%CI:1.948~27.748)及无结核病家族接触史(OR=5.232,95%CI:1.405~19.476);低认知-中等意愿-弱行为组危险因素为:无稳定职业(OR=8.089,95%CI:3.033~21.574)、治疗时长<3个月(OR=7.251,95%CI: 3.023~17.391)、无结核病家族接触史(OR=5.738,95%CI:2.565~12.835)、治疗时长为3~6个月(OR=3.465,95%CI:1.557~7.713)及无慢性病(OR=2.867,95%CI:1.293~6.361)。3组患者6个维度(疾病知识、药物管理、症状检测、饮食运动、消毒隔离、心理情绪)护理需求组间差异均有统计学意义。结论: 延续治疗期的初治肺结核患者自我管理行为存在显著异质性,职业稳定性、治疗时长、慢性疾病患病史、结核病家族接触史及年龄均为影响患者自我管理类别的重要因素。

关键词: 结核, 肺, 疾病管理, 模型, 统计学, 流行病学因素

Abstract:

Objective: To explore the latent class characteristics of self-management behaviors in pulmonary tuberculosis patients during their continuous treatment stage, analyze the influencing factors of different latent classes, and provide a reference for formulating individualized out-of-hospital intervention strategies. Methods: Using convenient sampling method, 403 pulmonary tuberculosis patients who completed initial treatment at Zhengzhou Sixth People’s Hospital from June to December 2025, were selected as research subjects. These patients were then transferred to home for continuous treatment and received follow-up visits. A general information questionnaire, the Self-management Scale for Tuberculosis Patients, and the Nursing Needs Questionnaire for Pulmonary Tuberculosis Patients Receiving Home Treatment were used to conduct a questionnaire survey, and Mplus 8.3 software was adopted for latent profile analysis. Results: The self-management behaviors of newly treated pulmonary tuberculosis patients during the continuous treatment stage could be divided into three latent classes: the low cognition-low willingness-moderately strong behavior group (24 cases, 6.0%), the low cognition-moderate willingness-weak behavior group (85 cases, 21.0%), and the high self-management group (294 cases, 73.0%). Multivariate logistic regression analysis revealed that, with the high self-management group as the reference group, the independent and relevant factors for the low cognition-low willingness-moderate behavior group were: no stable occupation (OR=14.737, 95%CI:2.995-72.501), treatment duration <3 months (OR=8.914, 95%CI:2.081-38.179), 3-6 months (OR=7.352, 95%CI:1.948-27.748), and no tuberculosis family contact history (OR=5.232, 95%CI:1.405-19.476); the risk factors for the low cognition-moderate willingness-weak behavior group were: no stable occupation (OR=8.089, 95%CI:3.033-21.574), treatment duration <3 months (OR=7.251, 95%CI:3.023-17.391), no family contact history (OR=5.738, 95%CI:2.565-12.835), treatment duration 3-6 months (OR=3.465, 95%CI:1.557-7.713), and no chronic diseases (OR=2.867, 95%CI:1.293-6.361). Conclusion: Self-management behaviors exhibit prominent heterogeneity among pulmonary tuberculosis patients receiving continuous treatment. Occupational stability, treatment duration, chronic disease history, family tuberculosis contact history, and age serve as key determinants of self-management subgroups.

Key words: Tuberculosis, pulmonary, Disease management, Models, statistical, Epidemiologic factors

中图分类号:

刘甜甜, 强杜佳一, 杨阿芳, 申琼阳, 朱兴花, 姚秀钰, 李洪智. 初治肺结核患者延续治疗期自我管理潜在剖面分析及护理策略[J]. 中国防痨杂志, 2026, 48(8): 1148-1157. doi: 10.19982/j.issn.1000-6621.20260080

Liu Tiantian, Qiang Dujiayi, Yang Afang, Shen Qiongyang, Zhu Xinghua, Yao Xiuyu, Li Hongzhi. Latent profile analysis of self-management and nursing strategies for newly treated pulmonary tuberculosis patients during continuous treatment stage[J]. Chinese Journal of Antituberculosis, 2026, 48(8): 1148-1157. doi: 10.19982/j.issn.1000-6621.20260080

图/表 6

表1

图1

表2

初治肺结核患者延续治疗期自我管理潜在类别的单因素分析

变量		合计 (403例)		低认知-低意愿- 中强行为组(24例)		低认知-中等意愿- 弱行为组(85例)		高自我管理组 (294例)		统计检验值		P值
年龄[岁,M(Q₁,Q₃)]		39.00 (23.75,58.00)		55.00 (24.00,66.50)		43.50 (31.25,63.00)		37.00 (21.75,56.00)		H=10.440		0.005
性别										χ²=36.944		<0.001
男性		329(81.6)		15(62.5)		53(62.4)		261(88.8)
女性		74(18.4)		9(37.5)		32(37.6)		33(11.2)
居住地										χ²=2.218		0.330
农村		222(55.1)		16(66.7)		48(56.5)		158(53.7)
城市		143(35.5)		8(33.3)		28(32.9)		107(36.4)
城乡结合部		38(9.4)		0(0.0)		9(10.6)		29(9.9)
教育程度										χ²=15.421		<0.001
小学及以下		45(11.2)		7(29.2)		20(23.5)		18(6.1)
初中		129(32.0)		6(25.0)		27(31.8)		96(32.7)
高中/大专及以上		229(56.8)		11(45.8)		38(44.7)		180(61.2)
婚姻状况										χ²=18.501		<0.001
有配偶		312(77.4)		13(54.2)		56(65.9)		243(82.7)
无配偶		91(22.6)		11(45.8)		29(34.1)		51(17.3)
宗教信仰										χ²=9.635		0.008
有		37(9.2)		4(16.7)		14(16.5)		19(6.5)
无		366(90.8)		20(83.3)		71(83.5)		275(93.5)
职业										χ²=20.545		<0.001
务农		140(34.7)		12(50.0)		31(36.5)		97(33.0)
无稳定工作		63(15.6)		9(37.5)		30(35.3)		24(8.2)
有稳定工作		200(49.7)		3(12.5)		24(28.2)		173(58.8)
家庭人均月收入(元)										χ²=100.674		<0.001
<3000		106(26.3)		17(70.9)		42(49.4)		47(16.0)
3000~6000		91(22.6)		5(20.8)		33(38.8)		53(18.0)
>6000		206(51.1)		2(8.3)		10(11.8)		194(66.0)
治疗时长(月)										χ²=69.322		<0.001
<3		69(17.1)		8(3.3)		34(40.0)		27(9.2)
3~6		121(30.0)		12(50.0)		31(36.5)		78(26.5)
>6		213(52.9)		4(16.7)		20(23.5)		189(64.3)
吸烟										χ²=1.545		0.462
是		45(11.2)		1(4.2)		16(18.8)		28(9.5)
既往吸烟已经戒烟		117(29.0)		9(37.5)		21(24.7)		87(29.6)
否		241(59.8)		14(58.3)		48(56.5)		179(60.9)
其他疾病										χ²=45.008		<0.001
有		227(56.3)		9(37.5)		23(27.1)		195(66.3)
无		176(43.7)		15(62.5)		62(72.9)		99(33.7)
结核病家族接触史									χ²=87.951		<0.001
有	237(58.8)		4(16.7)		19(22.4)		214(72.8)
无	166(41.2)		20(83.3)		66(77.6)		80(27.2)
居住情况									χ²=2.722		0.256
自己单独居住	82(20.3)		6(25.0)		12(14.1)		64(21.8)
与家人共同居住	321(79.7)		18(75.0)		73(85.9)		230(78.2)

表2

表3

表4

初治肺结核患者延续治疗期自我管理潜在类别的多元logistic回归分析

项目	β值		s${}_{\overline{\mathit{x}}}$值		Wald χ²值		P值		OR(95%CI)值
C1:低认知-低意愿-中强行为组(vs.C3:高自我管理组)
性别
男性	-0.374		0.559		0.449		0.503		0.688(0.230~2.055)
受教育程度
小学及以下	0.554		0.886		0.390		0.532		1.740(0.306~9.882)
初中	-0.786		0.709		1.230		0.267		0.456(0.114~1.828)
婚姻状况
有配偶	-1.207		0.743		2.642		0.104		0.299(0.070~1.282)
宗教信仰
无		-0.958	0.769	1.551		0.213		0.384(0.085~1.733)
职业
农民		1.095	0.823	1.769		0.184		2.989(0.595~15.006)
无稳定工作		2.690	0.813	10.953		<0.001		14.737(2.995~72.501)
家庭人均月收入(元)
<3000		1.727	0.905	3.636		0.057		5.622(0.953~33.162)
3000~6000		0.603	0.964	0.391		0.532		1.828(0.276~12.092)
治疗时长(月)
<3		2.188	0.742	8.687		0.003		8.914(2.081~38.179)
3~6		1.995	0.678	8.667		0.003		7.352(1.948~27.748)
其他疾病史
无		1.039	0.607	2.931		0.087		2.827(0.860~9.291)
结核病家族接触史
无		1.655	0.671	6.088		0.014		5.232(1.405~19.476)
年龄		0.042	0.023	3.309		0.069		1.042(0.997~1.090)
C2:低认知-中等意愿-弱行为组(vs.C3:高自我管理组)
性别
男性		-0.529	0.393	1.810		0.179		0.589(0.273~1.273)
受教育程度
小学及以下		0.964	0.646	2.229		0.135		2.622(0.740~9.297)
初中		-0.160	0.445	0.128		0.720		0.852(0.356~2.041)
婚姻状况
有配偶		-0.611	0.497	1.515		0.218		0.543(0.205~1.436)
宗教信仰
无		-1.033	0.543	3.617		0.057		0.356(0.123~1.032)
职业
农民		0.012	0.465	0.001		0.980		1.012(0.406~2.520)
无稳定职业		2.091	0.501	17.446		<0.001		8.089(3.033~21.574)
家庭人均月收入(元)
<3000		1.006	0.525	3.679		0.055		2.736(0.978~7.650)
3000~6000		0.816	0.509	2.565		0.109		2.260(0.833~6.133)
治疗时长(月)
<3		1.981	0.446	19.698		<0.001		7.251(3.023~17.391)
3~6		1.243	0.408	9.264		0.002		3.465(1.557~7.713)
其他疾病史
无		1.053	0.407	6.714		0.010		2.867(1.293~6.361)
结核病家族接触史
无		1.747	0.411	18.088		<0.001		5.738(2.565~12.835)
年龄		0.042	0.015	7.598		0.006		1.043(1.012~1.074)

表4

表5

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模型	LL	AIC	BIC	aBIC	LMR-LRT(P)	BLRT(P)	Entropy	类别概率
1	-4012.971	8037.943	8061.937	8042.898	-	-	-	1
2	-3451.282	6922.564	6962.553	6930.822	<0.001	<0.001	0.991	0.33/0.67
3	-3302.888	6633.777	6689.762	6645.338	0.002	<0.001	0.995	0.06/0.21/0.73
4	-3131.878	6299.756	6371.737	6314.621	0.005	<0.001	0.995	0.06/0.20/0.66/0.08
5	-3098.688	6241.376	6329.353	6259.544	0.584	<0.001	0.990	0.03/0.04/0.08/0.20/0.65

变量	赋值
年龄	原值代入
性别	女性=0,男性=1
受教育程度	高中/大专及以上=0,初中=1,小学及以下=2
婚姻状况	有配偶=0,无配偶=1
宗教信仰	有=0,无=1
职业	有稳定工作=0,农民=1,无稳定工作=2
家庭人均月收入	>6000元=0,3000~6000元=1,<3000元=2
治疗时长	>6个月=0,3~6个月=1,<3个月=2
其他病史	有=0,无=1
结核病家族接触史	有=0,无=1

组别	疾病知识	药物管理	症状检测	饮食运动	消毒隔离	心理情绪
低认知-低意愿-中强行为组(24例)	1.00 (0.82,1.31)	1.97 (1.53,2.42)	1.18 (0.90,1.46)	1.02 (0.79,1.30)	1.02 (0.81,1.29)	1.04 (0.80,1.32)
低认知-中等意愿-弱行为组(85例)	1.14 (0.95,1.42)	1.24 (1.01,1.50)	1.20 (0.98,1.48)	1.27 (1.03,1.55)	1.15 (0.92,1.41)	1.36 (1.10,1.64)
高自我管理组(294例)	2.02 (1.64,2.45)	2.12 (1.70,2.53)	2.14 (1.72,2.56)	2.10 (1.68,2.51)	3.01 (2.46,3.54)	2.97 (2.43,3.50)
合计(403例)	1.19 (0.93,1.52)	2.00 (1.61,2.44)	1.26 (0.98,1.57)	1.30 (1.01,1.62)	1.23 (0.96,1.55)	3.04 (2.41,3.58)
H值	11.022	12.047	10.344	11.217	10.687	11.214
P值	0.001	0.002	0.011	0.003	0.004	0.004