Heterogeneity of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation based on latent profile analysis
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摘要:
目的 探索儿童肝移植受者心理行为适应特征的异质性亚型及不同类别儿童肝移植受者的特征差异。 方法 选取741例接受活体肝移植手术儿童受者，由其照护者填写自制一般资料调查表、世界卫生组织5项身心健康指标（WHO-5）中文版量表及长处与困难问卷（SDQ）（家长版），进行调查。以SDQ 5个维度得分为模型的外显变量，采用潜在剖面分析构建儿童肝移植受者心理行为适应特征分类模型，分析儿童肝移植受者心理行为适应特征的潜在类别，并采用单因素分析和logistic回归分析潜在类别的影响因素。 结果 儿童肝移植受者心理行为适应特征存在3个潜在类别，分别为同伴交往问题组（302例）、心理行为适应组（145例）及心理行为调节困难组（294例）。将前两组合并为心理行为健康组（447例），与心理行为调节困难组（294例）在长处与困难问卷的5个维度得分及困难总分比较差异均有统计学意义（均为P<0.001）。logistic回归分析显示，年龄≤5岁、原发病为非胆汁淤积性肝病、主干家庭类型为儿童肝移植受者心理行为调节困难的危险因素，性别为女、父母教育水平高、照护者WHO-5得分高为儿童肝移植受者术后心理行为调节困难的保护因素（均为P<0.05）。 结论 儿童肝移植受者的心理行为适应特征存在异质性，医护人员应关注不同心理行为适应类别的儿童肝移植受者的不同特征，采取针对性的筛查和干预策略，以改善儿童肝移植受者的心理行为适应结局。 Abstract:Objective To explore heterogeneous subtypes of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation and the characteristics differences of different types of children after liver transplantation. Methods Seven hundred and forty-one children who underwent living-related liver transplantation were enrolled. The self-designed general information questionnaire, Chinese version of 5-Item World Health Organization Well-Being Index (WHO-5) and the parent-report version of the Strengths and Difficulties Questionnaire (SDQ) were filled out by their guardians. The scores of five dimensions of SDQ were used as the manifest variables of the model. The classification model of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation was constructed by latent profile analysis. The latent categories of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation were analyzed. The influencing factors of latent categories were analyzed by univariate analysis and logistic regression model. Results There were three latent categories of psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation, including peer communication problem group (n=302), psychological and behavioral adaptation group (n=145) and psychological and behavioral adjustment difficulty group (n=294). The first two groups were merged into the psychological and behavioral health group (n=447), which had significant differences in the five dimensions and the total score of difficulties of SDQ compared with the psychological and behavioral adjustment difficulty group (n=294) (all P<0.001). Logistic regression analysis showed that age≤5 years old, primary disease of non-cholestatic liver disease, stem family were the risk factors for psychological and behavioral adjustment difficulties in pediatric recipients after liver transplantation. Female gender, high education levels of parents and high WHO-5 score of guardians were the protective factors for psychological and behavioral adjustment difficulties in pediatric recipients after liver transplantation (all P<0.05). Conclusions The psychological and behavioral adaptation characteristics of pediatric recipients after liver transplantation are heterogeneous. Medical staff should pay extensive attention to different characteristics of pediatric recipients after liver transplantation with different psychological and behavioral adaptation categories and adopt targeted screening and intervention strategies, aiming to improve psychological and behavioral adaptation outcomes of pediatric recipients after liver transplantation. -
图 1 儿童肝移植受者心理行为适应特征的3个潜在类别剖面图
Figure 1. Three potential profiles of psychological and behavioral adaptation characteristics in children after liver transplantation
表 1 儿童肝移植受者心理行为适应特征的潜在剖面分析模型拟合标准
Table 1. Model fit criteria of latent profile analysis for psychological and behavioral adaptation characteristics in children after liver transplantation
模型 AIC BIC Entropy BLRT BLRT_P值 类别概率 1 15 514.740 15 560.820 — — — 1 2 15 014.820 15 111.580 0.649 521.919 0.010 0.549/0.451 3 14 921.420 15 068.870 0.696 115.398 0.010 0.408/0.196/0.396 4 14 887.790 15 085.930 0.697 55.628 0.010 0.364/0.139/0.359/0.138 5 14 851.960 15 100.800 0.678 57.827 0.010 0.339/0.135/0.278/0.167/0.081 6 14 826.570 15 126.090 0.670 47.391 0.010 0.331/0.130/0.127/0.200/0.132/0.080 
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表 2 不同儿童肝移植受者心理行为适应特征潜在类别在SDQ各领域得分的比较（$\bar {\boldsymbol{x}} $±s，分）
Table 2. Comparison of scores in different areas of SDQ in different latent classes of psychological and behavioral adaptation characteristics of children after liver transplantation
组别 n 情绪症状 品行问题 多动及注意力障碍 同伴交往问题 亲社会行为 适应困难总分 C1组 302 1.8±1.3 1.9±1.0 4.3±1.7 2.7±1.4 6.5±1.5 10.7±2.8 C2组 145 1.6±1.4 1.8±1.2 4.2±2.3 1.6±1.2a 9.5±0.5a 9.1±3.4a C3组 294 4.3±2.1a,b 3.7±1.6a,b 6.9±1.9a,b 3.8±1.7a,b 5.8±2.4a,b 18.7±3.5a,b H值 −16.113 −15.974 −15.376 −11.461 −8.925 −22.305 P值 <0.001 <0.001 <0.001 <0.001 <0.001 <0.001 注：与C1组比较，aP< 0.05；与C2组比较，bP< 0.05。
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表 3 儿童肝移植受者心理行为适应特征潜在类别的单因素分析
Table 3. Univariate analysis of latent classes of psychological behavior adaptation characteristics in children after liver transplantation
变量 心理行为健康组（n=447） 心理行为调节困难组（n=294） χ2值/Z值 P值 性别[n（%）] 5.598 0.018 男 190（42.5） 151（51.4） 女 257（57.5） 143（48.6） 年龄[n（%）] 16.962 <0.001 ≤5岁 274（61.3） 135（45.9） >5岁 173（38.7） 159（54.1） 是否为独生子女[n（%）] 1.765 0.184 是 172（38.5） 99（33.7） 否 275（61.5） 195（66.3） 每日中等强度体力活动时长[n（%）] 3.039 0.081 ≤30 min 210（47.0） 119（40.5） >30 min 237（53.0） 175（59.5） 主要照护者[n（%）] 2.708 0.100 母亲 356（79.6） 219（74.5） 其他 91（20.4） 75（25.5） 父母教育水平[n（%）] 20.691 <0.001 高中及以下 113（25.3） 121（41.2） 本科及以上 334（74.7） 173（58.8） 家庭类型[n（%）] 10.993 0.004 核心家庭 222（49.7） 111（37.8） 主干家庭 203（45.4） 160（54.4） 其他 22（4.9） 23（7.9） 家庭年收入[n（%）] 8.271 0.082 <30 000元 94（21.0） 67（22.8） 30 000~50 000元 90（21.0） 67（22.8） 50 001~100 000元 97（21.7） 57（19.4） >100 000元 123（27.5） 60（20.4） 未知 43（9.6） 30（10.2） 原发病[n（%）] 9.676 0.002 胆汁淤积性肝病 403（90.2） 242（82.3） 非胆汁淤积性肝病 44（9.8） 52（17.7） 移植年龄[n（%）] 1.302 0.254 ≤1岁 261（58.4） 184（62.6） >1岁 186（41.6） 110（37.4） 随访时间[n（%）] 0.031 0.861 ≤3年 216（48.3） 144（49.0） >3年 231（51.7） 150（51.0） 免疫抑制方案[n（%）] 0.350 0.554 他克莫司 376（84.1） 252（85.7） 环孢素 71（15.9） 42（14.3） BMI[M（P25，P75），kg/m2] 16（15，18） 16（15，18） −0.188 0.851 照护者WHO-5得分[M（P25，P75），分] 15（11，18） 13（8，16） −4.749 <0.001
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表 4 儿童肝移植受者心理行为适应特征潜在类别的logistic回归分析
Table 4. Logistic regression analysis of latent classes of psychological behavior adaption characteristics in children after liver transplantation
变量 β值 标准误 Wald χ2值 OR①值 95%CI② P值 常量 0.565 0.282 4.009 1.759 −③ 0.045 性别 −0.321 0.159 4.072 0.725 0.531~0.991 0.044 年龄 0.609 0.161 14.350 1.838 1.342~2.519 <0.001 父母教育水平 −0.724 0.168 18.468 0.485 0.349~0.675 <0.001 家庭类型 核心家庭 − − 10.795 − − 0.005 主干家庭 0.520 0.166 9.823 1.682 1.215~2.328 0.002 其他 0.598 0.335 3.178 1.819 0.942~3.510 0.075 原发病 0.579 0.234 6.119 1.785 1.128~2.824 0.013 照护者WHO-5得分 −0.074 0.015 22.849 0.929 0.901~0.957 <0.001 注：①OR为比值比。
②CI为可信区间。
③−为无数据。
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