应对方式对COPD并发急性肺部感染患者疾病不确定感与焦虑症状的中介效应分析-现代医学

应对方式对COPD并发急性肺部感染患者疾病不确定感与焦虑症状的中介效应分析

单位：首都医科大学附属北京天坛医院急诊科, 北京 100070

分类号：R563.9

出版年·卷·期（页码）：2026·45·第四期（690-698）

摘要：

目的： 探讨应对方式在慢性阻塞性肺疾病(COPD)并急性肺部感染患者疾病不确定感与焦虑症状的中介效应。方法： 以便利抽样法选取2022年12月—2024年12月首都医科大学附属北京天坛医院152例COPD合并急性肺部感染患者为研究对象，应用一般资料调查表、简易应对方式量表(SCSQ)、中文版Mishel疾病不确定感量表(MUIS)、医院焦虑抑郁量表焦虑分量表(HADS-A)调查患者一般资料、应对方式、疾病不确定感、焦虑症状。应用Pearson相关系数模型探讨应对方式、疾病不确定感与患者焦虑症状的相关性；多元线性回归模型分析患者焦虑症状的相关因素；Amos 26.0软件构建中介效应模型探讨应对方式在COPD合并急性肺部感染患者疾病不确定感、焦虑症状间的中介作用。结果： 152例COPD合并急性肺部感染患者SCSQ量表积极应对维度与消极应对维度、MUIS、HADS-A量表评分分别为(19.32±3.69)分、(13.04±3.15)分、(85.70±7.93)分、(7.13±2.27)分。Pearson相关分析结果显示，COPD合并急性肺部感染患者SCSQ量表积极应对维度评分与HADS-A评分呈负相关(r=-0.384，P＜0.001)，SCSQ量表消极应对维度评分、MUIS评分与HADS-A评分呈正相关(r=0.438、0.495，均P＜0.001)。多元线性回归分析显示，呼吸困难分级、近1年因COPD急性加重住院次数、SCSQ量表消极应对维度评分、MUIS评分是患者焦虑症状的危险因素，SCSQ量表积极应对维度评分是其保护因素(P＜0.05)。中介效应模型发现，控制呼吸困难分级、近1年因COPD急性加重住院次数混杂因素后，模型仍拟合良好且各路径对应置信区间均不包含0。疾病不确定感通过积极应对方式对患者焦虑症状的间接效应值为0.049，疾病不确定感通过消极应对方式对患者焦虑症状的间接效应值为0.086，中介效应占总效应的26.11%。结论： COPD合并急性肺部感染患者焦虑症状不容忽视，应对方式在患者疾病不确定感与焦虑间具有部分中介作用，改善患者应对方式，减轻疾病不确定感，可能是缓解焦虑症状的有效途径。

Objective: To explore the mediating effect of coping style between illness uncertainty and anxiety symptoms in patients with chronic obstructive pulmonary disease(COPD) complicated by acute pulmonary infection. Methods: A total of 152 patients with COPD complicated by acute pulmonary infection at Beijing Tiantan Hospital, Capital Medical University from December 2022 to December 2024 were enrolled using convenience sampling method. The general information questionnaire, Simplified Coping Style Questionnaire(SCSQ), Chinese version of Mishel Uncertainty in Illness Scale(MUIS), and Hospital Anxiety and Depression Scale-Anxiety subscale(HADS-A) were used to investigate patients' general information, coping style, illness uncertainty, and anxiety symptoms. Pearson correlation coefficient model was applied to explore the correlation between coping style, illness uncertainty, and patients' anxiety symptoms. Multiple linear regression model was used to analyze the associated factors of patients' anxiety symptoms. Amos 26.0 software was used to construct a mediating effect model to explore the mediating role of coping style between illness uncertainty and anxiety symptoms in patients with COPD complicated by acute pulmonary infection. Results: Among the 152 patients with COPD complicated by acute pulmonary infection, the scores for the positive coping dimension and negative coping dimension of the SCSQ scale, MUIS, and HADS-A scale were(19.32±3.69),(13.04±3.15),(85.70±7.93), and(7.13±2.27), respectively. Pearson correlation analysis results showed that the positive coping dimension score of the SCSQ scale in patients with COPD complicated by acute pulmonary infection was negatively correlated with HADS-A score(r=-0.384, P<0.001), while the negative coping dimension score of the SCSQ scale and MUIS score were positively correlated with HADS-A score(r=0.438, 0.495, both P<0.001). Multiple linear regression analysis showed that dyspnea grade, number of hospitalizations due to acute exacerbation of COPD in the past year, negative coping dimension score of the SCSQ scale, and MUIS score were risk factors of patients' anxiety symptoms, while the positive coping dimension score of the SCSQ scale was a protective factor(P<0.05). The mediating effect model revealed that after controlling for confounding factors including dyspnea grade and number of hospitalizations due to acute exacerbation of COPD in the past year, the model still demonstrated good fit and the confidence intervals corresponding to each path did not include zero. The indirect effect value of illness uncertainty on patients' anxiety symptoms through positive coping style was 0.049, and the indirect effect value of illness uncertainty on patients' anxiety symptoms through negative coping style was 0.086, with the mediating effect accounting for 26.11% of the total effect. Conclusion: Anxiety symptoms in patients with COPD complicated by acute pulmonary infection should not be overlooked. Coping style has a partial mediating role between patients' illness uncertainty and anxiety. Improving patients' coping style and reducing illness uncertainty may be effective approaches to alleviate anxiety symptoms.

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