Background：Previous studies have shown that hypertension is an important factor contributing to the occurrence and progression of diabetic kidney damage.However,the relationship between the patterns of blood pressure...Background：Previous studies have shown that hypertension is an important factor contributing to the occurrence and progression of diabetic kidney damage.However,the relationship between the patterns of blood pressure （BP） trajectory and kidney damage in the diabetic population remains unclear.This prospective study investigated the effect of long-term systolic BP （SBP） trajectory on kidney damage in the diabetic population based on an 8-year follow-up community-based cohort.Methods：This study included 4556 diabetic participants among 101,510 participants.BP,estimated glomerular filtration rate （eGFR）,and urinary protein were measured every 2 years from 2006 to 2014.SBP trajectory was identified by the censored normal modeling.Five discrete SBP trajectories were identified according to SBP range and the changing pattern over time.Kidney damage was evaluated through eGFR and urinary protein value.A multivariate logistic regression model was used to analyze the influence of different SBP trajectory groups on kidney damage.Results：We identified five discrete SBP trajectories：low-stable group （n =864）,moderate-stable group （n =1980）,moderate increasing group （n =609）,elevated decreasing group,（n =679）,and elevated stable group （n =424）.The detection rate of kidney damage in the low-stable group （SBP：118-124 mmHg） was the lowest among the five groups.The detection rate of each kidney damage index was higher in the elevated stable group （SBP：159-172 mmHg） compared with the low-stable group.For details,the gap was 4.14 （11.6% vs.2.8%） in eGFR 〈60 ml.min-1.1.73 m 2 and 3.66 （17.2% vs.4.7%）,3.38 （25.0% vs.7.4%）,and 1.8 （10.6% vs.5.9%） times in positive urinary protein,eGFR 〈60 ml.min-1.1.73 m 2 and/or positive urinary protein,and eGFR decline ≥30%,respectively （P 〈 0.01）.Conclusion：An elevated stable SBP trajectory is an independent risk factor for kidney damage in the diabetic population.展开更多
追踪研究当中,交叉滞后模型可以探究多变量之间往复式影响,潜增长模型可以探究个体增长趋势。对两类模型进行整合,例如同时关注往复式影响与个体增长趋势,同时可以定义测量误差、随机截距等变异成分,衍生出随机截距交叉滞后模型、特质−...追踪研究当中,交叉滞后模型可以探究多变量之间往复式影响,潜增长模型可以探究个体增长趋势。对两类模型进行整合,例如同时关注往复式影响与个体增长趋势,同时可以定义测量误差、随机截距等变异成分,衍生出随机截距交叉滞后模型、特质−状态−误差模型、自回归潜增长模型、结构化残差潜增长模型等。以交叉滞后模型和潜增长模型分别作为基础模型,从个体间/个体内变异分解的角度对上述各类模型梳理,整合出此类模型的分析框架,并拓展建立“因子结构化潜增长模型(factor latent curve model with structured reciprocals)”作为统合框架。通过实证研究(早期儿童的追踪研究−幼儿园版,ECLS-K),建立21049名儿童的阅读和数学能力的往复式影响与增长趋势。研究发现,分离了稳定特质的模型拟合最优。研究也对模型建模思路和模型选择提供了建议。展开更多
目的探讨全髋关节置换术(total hip arthroplasty,THA)术后患者运动恐惧发展轨迹及影响因素。方法采用方便抽样法,选取2023年2月—6月武汉市3所三级甲等医院THA术后患者作为研究对象。在患者术后1~2 d(T1)发放一般情况调查表、恐动症Ta...目的探讨全髋关节置换术(total hip arthroplasty,THA)术后患者运动恐惧发展轨迹及影响因素。方法采用方便抽样法,选取2023年2月—6月武汉市3所三级甲等医院THA术后患者作为研究对象。在患者术后1~2 d(T1)发放一般情况调查表、恐动症Tampa评分量表、运动自我效能量表、骨科社会支持量表、广泛性焦虑障碍量表、患者健康问卷抑郁量表和疼痛视觉模拟评分表,术后1周(T2)、1个月(T3)、3个月(T4)时,再次采用上述量表进行调查,评估其运动恐惧水平及生理、心理状况。采用潜类别增长模型对运动恐惧轨迹进行分类,并分析不同类别运动恐惧的影响因素。结果共纳入263例THA术后患者,其运动恐惧轨迹分为4个潜在类别,分别为C1高运动恐惧持续组29例、C2中运动恐惧改善组41例、C3低运动恐惧改善组131例、C4无运动恐惧组62例。无序多分类logistic回归分析显示,相较于C4无运动恐惧组,THA患者运动恐惧轨迹类别发展为C1高运动恐惧持续组的影响因素为年龄[比值比(odds ratio,OR)=1.081,95%置信区间(confidence interval,CI)(1.025,1.140)]、有合并症[OR=6.471,95%CI(1.831,22.872)]、T1~T4时间点运动自我效能评分均分[OR=0.867,95%CI(0.808,0.931)]和T1~T4时间点疼痛评分均分[OR=7.981,95%CI(1.718,37.074)],发展为C2中运动恐惧改善组的影响因素为年龄[OR=1.049,95%CI(1.010,1.089)]、文化程度[OR=0.244,95%CI(0.085,0.703)]和T1~T4时间点疼痛评分均分[OR=8.357,95%CI(2.300,30.368)],发展为C3低运动恐惧改善组的影响因素为T1~T4时间点的运动自我效能评分均分[OR=0.871,95%CI(0.825,0.920)]和疼痛评分均分[OR=4.167,95%CI(1.544,11.245)]。结论THA术后患者的运动恐惧呈现不同的变化轨迹,护士应重视对高龄、文化程度低、合并慢性疾病、运动自我效能低下、疼痛水平高的患者运动恐惧的评估和干预。展开更多
文摘Background：Previous studies have shown that hypertension is an important factor contributing to the occurrence and progression of diabetic kidney damage.However,the relationship between the patterns of blood pressure （BP） trajectory and kidney damage in the diabetic population remains unclear.This prospective study investigated the effect of long-term systolic BP （SBP） trajectory on kidney damage in the diabetic population based on an 8-year follow-up community-based cohort.Methods：This study included 4556 diabetic participants among 101,510 participants.BP,estimated glomerular filtration rate （eGFR）,and urinary protein were measured every 2 years from 2006 to 2014.SBP trajectory was identified by the censored normal modeling.Five discrete SBP trajectories were identified according to SBP range and the changing pattern over time.Kidney damage was evaluated through eGFR and urinary protein value.A multivariate logistic regression model was used to analyze the influence of different SBP trajectory groups on kidney damage.Results：We identified five discrete SBP trajectories：low-stable group （n =864）,moderate-stable group （n =1980）,moderate increasing group （n =609）,elevated decreasing group,（n =679）,and elevated stable group （n =424）.The detection rate of kidney damage in the low-stable group （SBP：118-124 mmHg） was the lowest among the five groups.The detection rate of each kidney damage index was higher in the elevated stable group （SBP：159-172 mmHg） compared with the low-stable group.For details,the gap was 4.14 （11.6% vs.2.8%） in eGFR 〈60 ml.min-1.1.73 m 2 and 3.66 （17.2% vs.4.7%）,3.38 （25.0% vs.7.4%）,and 1.8 （10.6% vs.5.9%） times in positive urinary protein,eGFR 〈60 ml.min-1.1.73 m 2 and/or positive urinary protein,and eGFR decline ≥30%,respectively （P 〈 0.01）.Conclusion：An elevated stable SBP trajectory is an independent risk factor for kidney damage in the diabetic population.
文摘追踪研究当中,交叉滞后模型可以探究多变量之间往复式影响,潜增长模型可以探究个体增长趋势。对两类模型进行整合,例如同时关注往复式影响与个体增长趋势,同时可以定义测量误差、随机截距等变异成分,衍生出随机截距交叉滞后模型、特质−状态−误差模型、自回归潜增长模型、结构化残差潜增长模型等。以交叉滞后模型和潜增长模型分别作为基础模型,从个体间/个体内变异分解的角度对上述各类模型梳理,整合出此类模型的分析框架,并拓展建立“因子结构化潜增长模型(factor latent curve model with structured reciprocals)”作为统合框架。通过实证研究(早期儿童的追踪研究−幼儿园版,ECLS-K),建立21049名儿童的阅读和数学能力的往复式影响与增长趋势。研究发现,分离了稳定特质的模型拟合最优。研究也对模型建模思路和模型选择提供了建议。
