Abstract:

Objective To investigate the associations among symptom clusters in kidney transplant patients，examine their correlations with various domains of quality of life，and identify both core and bridge symptom clusters，thereby providing a basis for developing targeted symptom cluster management strategies. Methods Convenience sampling was adopted to recruit 451 kidney transplant patients who received outpatient follow-up in a tertiary A hospital in Tianjin from April 2025 to October 2025. Data were collected using a general information questionnaire，the Chinese version of the Modified Transplant Symptom Occurrence and Symptom Distress Scale，and the Quality of Life Scale for Patients of Renal Transplantation. Symptom clusters were extracted by exploratory factor analysis. R 4.4.0 software was used to construct an integrated symptom clusters-quality of life network，calculate metrics including strength and bridge strength centrality，and evaluate the stability of the network structure. Results A total of 432 valid questionnaires were recovered. The most common symptoms in 432 kidney transplant patients were hair thinning or hair loss（38.66%），difficulty falling asleep（36.34%），fatigue（33.10%），hand tremor（31.94%），and difficulty concentrating or poor memory（28.94%）. A total of 7 symptom clusters were identified，including the fatigue-cognition-related symptom cluster，the emotion-related symptom cluster，the hormone-related symptom cluster，the metabolism-related symptom cluster，the vision-hair symptom cluster，the joint pain-diarrhea symptom cluster，and the acne-constipation symptom cluster. The combined symptom clusters-quality of life network analysis revealed that the fatigue-cognition-related symptom cluster was the core symptom cluster（r_s=1.007），while the emotion-related symptom cluster served as the bridge symptom cluster（r_bs=1.244）. Psychological function exhibited the highest strength centrality（r_s=1.064） and bridge strength centrality（r_bs=2.622）. The network showed high accuracy and stability，and was found to be reliable. Conclusion Medical staff can mitigate interactions among symptoms within the fatigue-cognition-related and emotion-related symptom clusters through cognitive behavioral therapy. By taking into account the individual characteristics of kidney transplant patients，medical staff can prioritize psychological functioning as a core intervention target to comprehensively enhance quality of life.

Key words: Kidney Transplantation, Symptom Cluster, Quality of Life, Network Analysis, Nursing Care

摘要：

目的 调查肾移植患者症状群间的关联关系，并探讨其与生活质量各维度的相关性，识别核心症状群与桥梁症状群，为制订针对性的症状群管理策略提供依据。 方法 采用便利抽样法，选取2025年4—10月于天津市某三级甲等医院门诊随访的451例肾移植患者作为调查对象，使用一般资料调查表、中文版改良移植症状发生和症状困扰量表、肾移植患者生活质量相关评定量表进行调查，通过探索性因子分析提取症状群，采用R 4.4.0软件构建症状群-生活质量组合网络，计算强度、桥梁强度中心性，同时评估网络结构的稳定性。 结果 回收有效问卷432份。432例肾移植患者症状发生率较高的症状是头发稀疏或脱发（38.66%）、入睡困难（36.34%）、感到疲劳（33.10%）、手颤（31.94%）、难以集中注意力或记性差（28.94%）。共提取7个症状群，为疲劳-认知相关症状群、情绪相关症状群、激素相关症状群、代谢相关症状群、视觉-毛发症状群、关节痛-腹泻症状群、痤疮-便秘症状群。症状群-生活质量组合网络分析结果显示，疲劳-认知相关症状群为核心症状群（r_s=1.007），情绪相关症状群为桥梁症状群（r_bs=1.244），心理功能的强度中心性（r_s=1.064）和桥梁强度中心性（r_bs=2.622）均最高。经检验，网络的准确性和稳定性较好，网络模型可靠。 结论 医护人员可通过认知行为疗法减弱疲劳-认知相关症状群、情绪相关症状群内症状的相互作用，并结合肾移植患者个体特征，将心理功能维护作为核心干预方向，以全面提升患者的生活质量。

关键词: 肾移植, 症状群, 生活质量, 网络分析, 护理