肝移植患者衰弱变化轨迹及影响因素研究

doi:10.3761/j.issn.0254-1769.2025.24.007

摘要/Abstract

摘要：

目的探究肝移植患者衰弱变化轨迹及影响因素，为开展肝移植患者衰弱管理提供依据。方法采用便利抽样法，选取2021年10月—2023年1月在青岛市某三级甲等医院肝移植科的210例肝移植患者为调查对象，采用一般资料调查表、肝脏衰弱指数、国际体力活动问卷、微型营养评定量表简表、领悟社会支持量表、匹兹堡睡眠质量指数、医院焦虑抑郁量表、心理弹性量表收集患者资料，结合潜类别增长模型识别衰弱变化轨迹类别并分析其影响因素。结果回收有效问卷201份，有效问卷回收率为95.53%。T1~T6衰弱得分分别为（7.39±1.53）（9.27±2.80）（9.52±2.88）（6.96±2.10）（4.98±1.37）（3.17±1.31）分，识别出低水平缓慢下降组（68.16%）和高水平快速下降组（31.84%）2条衰弱变化轨迹。Logistic回归分析显示，年龄、原发病、糖尿病、多重用药、术后并发症数量、术前1周的营养状况、术后第2周的睡眠质量、术后1个月的躯体活动、术后3个月的焦虑水平是肝移植患者衰弱变化轨迹的影响因素（P<0.05）。结论肝移植患者衰弱变化轨迹呈现显著群体异质性，护士应重视年龄较大、合并糖尿病、并发症多、营养状况差、睡眠质量差、躯体活动少、焦虑水平高的患者的衰弱评估，并给予针对性的衰弱干预措施。

关键词: 肝移植, 衰弱, 影响因素分析, 潜类别增长模型, 护理

Abstract:

Objective To explore the trajectory and influencing factors of frailty in liver transplant recipients，in order to provide evidence for clinical management of frailty in this population. Methods With the method for convenience sampling，210 patients who listed on the transplant waiting list in the liver transplantation department of a tertiary hospital in Qingdao from October 2021 to January 2023 were selected. The data of patients were collected by the general information questionnaire，the Liver Frailty Index Scale，the International Physical Activity Questionnaire，the Mini Nutritional Assessment Scale，the Perceived Social Support Scale，the Pittsburgh Sleep Quality Index Scale，the Hospital Anxiety and Depression Scale，and the Resilience Scale，by combining with the latent category growth model，to identify the frailty trajectory category，and to analyze its factors. Results 201 valid questionnaires were collected, with a valid questionnaire recovery rate of 95.53%. The LFI scores of T1-T6 patients were（7.39±1.53），（9.27±2.80），（9.52±2.88），（6.96±2.10），（4.98±1.37），（3.17±1.31）. 2 distinct trajectories were identified，including “low level-slow decline group”（68.16%） and “high level-rapid decline group”（31.84%）. Binary logistic regression analysis showed that age，primary disease，diabetes，polypharmacy，number of postoperative complications，nutritional status T1，sleep quality T2，physical activity T3，and anxiety T4 were the influencing factors of frailty trajectory in liver transplant recipients（P<0.05）. Conclusion The trajectory of frailty in liver transplant recipients showed significant group heterogeneity. Healthcare providers should prioritize frailty assessment in patients with advanced age，diabetes，multiple comorbidities，poor nutritional status，impaired sleep quality，low physical activity levels，and high anxiety，and implement targeted frailty interventions for these individuals.

Key words: Liver Transplantation, Frailty, Root Cause Analysis, Latent Class Growth Model, Nursing Care

孙菊, 孙慧慧, 庄金珊, 郝小晨, 孟凡娟, 程莉洁, 张胜龙, 张丙良. 肝移植患者衰弱变化轨迹及影响因素研究[J]. 中华护理杂志, 2025, 60(24): 2993-2999.

SUN Ju, SUN Huihui, ZHUANG Jinshan, HAO Xiaochen, MENG Fanjuan, CHENG Lijie, ZHANG Shenglong, ZHANG Bingliang. Analysis of latent classes and influencing factors of frailty trajectories in liver transplant recipients[J]. Chinese Journal of Nursing, 2025, 60(24): 2993-2999.

图/表 4

表1 肝移植患者衰弱变化潜在类别的单因素分析（n=201，$\bar{x}±s$）

Table 1 Univariate analysis of potential categories of frailty in liver transplant recipients（n=201，$\bar{x}±s$）

表2 肝移植患者衰弱变化轨迹潜类别增长模型拟合指标（n=201）

Table 2 LCGM fitting index of trajectory of frailty in liver transplant recipients（n=201）

图1 肝移植患者衰弱变化潜类别增长模型轨迹

Figure 1 LCGM frailty trajectory in liver transplant recipients

表3 肝移植患者衰弱变化轨迹Logistic回归分析（n=201）

Table 3 Results of binary Logistic regression analysis of the classes of frailty trajectory in liver transplant recipients（n=201）

参考文献 25

[1]	McAdams-DeMarco MA, Law A, King E, et al. Frailty and mor-tality in kidney transplant recipients[J]. Am J Transplant, 2015, 15(1):149-154. DOI PMID
[2]	Ghelichi-Ghojogh M, Rajabi A, Mohammadizadeh F, et al. Survi-val rate of liver transplantation in Asia:a systematic review and meta-analysis[J]. Iran J Public Health, 2022, 51(10):2207-2220. DOI PMID
[3]	Mokdad AA, Lopez AD, Shahraz S, et al. Liver cirrhosis morta-lity in 187 countries between 1980 and 2010:a systematic analysis[J]. BMC Med, 2014, 12:145. DOI PMID
[4]	Ayorinde T, Panayotova G, Sharma A, et al. Clinical and bio-marker assessment of frailty in liver transplantation[J]. Curr Opin Organ Transplant, 2021, 26(5):488-497. DOI URL
[5]	Dolgin NH, Martins PNA, Movahedi B, et al. Functional status predicts postoperative mortality after liver transplantation[J]. Clin Transplant, 2016, 30(11):1403-1410. DOI PMID
[6]	Lai JC, Dodge JL, Kappus MR, et al. Changes in frailty are associated with waitlist mortality in patients with cirrhosis[J]. J Hepatol, 2020, 73(3):575-581. DOI PMID
[7]	Lai JC, Segev DL, McCulloch CE, et al. Physical frailty after liver transplantation[J]. Am J Transplant, 2018, 18(8):1986-1994. DOI PMID
[8]	Bhanji RA, Narayanan P, Moynagh MR, et al. Differing impact of sarcopenia and frailty in nonalcoholic steatohepatitis and alcoholic liver disease[J]. Liver Transpl, 2019, 25(1):14-24. DOI URL
[9]	Victor DW 3rd, Zanetto A, Montano-Loza AJ, et al. The role of preoperative optimization of the nutritional status on the improvement of short-term outcomes after liver transplantation? A review of the literature and expert panel recommendations[J]. Clin Transplant, 2022, 36(10):e14647. DOI URL
[10]	Tandon P, Tangri N, Thomas L, et al. A rapid bedside screen to predict unplanned hospitalization and death in outpatients with cirrhosis:a prospective evaluation of the clinical frailty scale[J]. Am J Gastroenterol, 2016, 111(12):1759-1767. DOI URL
[11]	王璐, 卢芳燕, 吕斐翠, 等. 肝移植受者术前衰弱现状及影响因素研究[J]. 中华护理杂志, 2024, 59(22):2710-2715. DOI URL
	Wang L, Lu FY, Lü FC, et al. The current status and inf-luencing factors analysis of frailty in liver transplant candi-dates[J]. Chin J Nurs, 2024, 59(22):2710-2715.
[12]	郭利敏, 孟萌, 关玉珠, 等. 肝移植受者衰弱的研究进展[J]. 中华护理杂志, 2020, 55(8):1265-1270. DOI URL
	Guo LM, Meng M, Guan YZ, et al. Frailty in liver transplant recipients:a literature review[J]. Chin J Nurs, 2020, 55(8):1265-1270.
[13]	孙慧慧, 孙菊, 程莉洁, 等. 肝移植受者术前预康复的研究进展[J]. 护理学报, 2022, 29(15):39-44. DOI
	Sun HH, Sun J, Cheng LJ, et al. Research progress on preope-rative rehabilitation of liver transplant recipients[J]. J Nurs China, 2022, 29(15):39-44.
[14]	方积乾. 生物医学研究的统计方法[M]. 北京: 高等教育出版社, 2007.
	Fang JQ. Statistical methods for biomedical research[M]. Bei-jing: Higher Education Press, 2007.
[15]	Lai JC, Covinsky KE, McCulloch CE, et al. The liver frailty index improves mortality prediction of the subjective clinician assessment in patients with cirrhosis[J]. Am J Gastroenterol, 2018, 113(2):235-242. DOI PMID
[16]	屈宁宁, 李可基. 国际体力活动问卷中文版的信度和效度研究[J]. 中华流行病学杂志, 2004, 25(3):87-90.
	Qu NN, Li KJ. Study on the reliability and validity of the Chinese version of International Physical Activity Question-naire[J]. Chin J Epidemiol, 2004, 25(3):87-90.
[17]	Rubenstein LZ, Harker JO, Salvà A, et al. Screening for un-dernutrition in geriatric practice:developing the short-form mini-nutritional assessment(MNA-SF)[J]. J Gerontol A Biol Sci Med Sci, 2001, 56(6):M366-M372. DOI URL
[18]	刘贤臣, 唐茂芹, 胡蕾, 等. 匹兹堡睡眠质量指数的信度和效度研究[J]. 中华精神科杂志, 1996, 29(2):103-107.
	Liu XC, Tang MQ, Hu L, et al. Reliability and validity of the Pittsburgh sleep quality index[J]. Chin J Psychiatry, 1996, 29(2):103-107.
[19]	Zigmond AS, Snaith RP. The hospital anxiety and depression scale[J]. Acta Psychiatr Scand, 1983, 67(6):361-370. DOI URL
[20]	张帆, 朱树贞, 邓平基. 领悟社会支持量表在国内住院病人社会支持研究中的应用评价[J]. 护理研究, 2018, 32(13):2048-2052.
	Zhang F, Zhu SZ, Deng PJ. Evaluation of the application of perceived social support scale in the study of social support for inpatients in China[J]. J Nurs Res, 2018, 32(13):2048-2052.
[21]	于肖楠, 张建新. 自我韧性量表与Connor-Davidson韧性量表的应用比较[J]. 心理科学, 2007, 30(5):1169-1171.
	Yu XN, Zhang JX. A comparison between the Chinese version of Ego-Resiliency Scale and Connor-Davidson Resilience Scale[J]. Psychol Sci, 2007, 30(5):1169-1171.
[22]	中华医学会肝病学分会, 中华医学会消化病学分会. 终末期肝病临床营养指南[J]. 临床医学研究与实践, 2019, 4(19):201.
	Chinese Society of Hepatology,Chinese Medical Association; Chinese Society of Gastroenterology,Chinese Medical Associa-tion. Clinical guidelines on nutrition in end-stage liver disease[J]. Clin Res Pract, 2019, 4(19):201.
[23]	Burkhalter H, Sereika SM, Engberg S, et al. Validity of 2 sleep quality items to be used in a large cohort study of kidney transplant recipients[J]. Prog Transplant, 2011, 21(1):27-35. DOI PMID
[24]	路梦新, 徐晓玮, 程莉洁, 等. 成人肝移植患者术后自我管理问题提示列表的构建及应用研究[J]. 中华护理杂志, 2025, 60(14):1709-1715. DOI URL
	Lu MX, Xu XW, Cheng LJ, et al. Construction and preliminary application of a self-management question prompt list in adult liver transplant recipients[J]. Chin J Nurs, 2025, 60 (14):1709-1715. DOI URL
[25]	Paka P, Lieber SR, Lee RA, et al. Perioperative glucose mana-gement and outcomes in liver transplant recipients:a quali-tative systematic review[J]. World J Transplant, 2018, 8(3):75. DOI URL