疾病不确定感在尿毒症透析患者健康素养与焦虑水平间的中介效应

doi:10.3969/j.issn.1004-583X.2026.04.005

摘要/Abstract

摘要：

目的探讨疾病不确定感在尿毒症透析患者健康素养与焦虑水平间的中介效应。方法采用便利抽样法,选取2021年4月-2025年4月南阳市第三人民医院收治的尿毒症透析患者127例。根据疾病不确定感量表(mishel uncertainty in illness scale,MUIS)、慢性病患者健康素养量表(health literacy scale for chronic patients,HLSCP)和焦虑自评量表(self-rating anxiety scale,SAS)得分评估患者疾病不确定感、健康素养和焦虑水平。采用Pearson相关分析探究检验变量的关联性;采用分层回归分析及Bootstrap抽样法检验疾病不确定感在健康素养与焦虑水平间的中介效应。结果本研究共发放127份问卷,回收有效问卷116份(91.34%)。116例尿毒症透析患者的MUIS总分为(75.13±18.76)分、HLSCP总分为(64.28±10.97)分、SAS总分为(56.82±6.44)分。Pearson相关性分析显示,MUIS总分与SAS总分呈正相关(P<0.05),与HLSCP总分呈负相关(P<0.05);HLSCP总分与SAS总分呈负相关(P<0.05)。中介效应分析表明,疾病不确定感在尿毒症透析患者健康素养与焦虑水平间起部分中介效应,中介效应占总效应的53.4%。结论疾病不确定感是尿毒症透析患者健康素养影响焦虑水平的重要中介机制。临床干预中可通过提高健康素养并降低疾病不确定感,从而缓解患者的焦虑症状。

关键词: 尿毒症, 透析, 疾病不确定感, 健康素养, 焦虑, 中介效应

Abstract:

Objective To investigate the mediating effect of disease uncertainty on the relationship between health literacy and anxiety in uremic dialysis patients. Methods Using convenience sampling, 127 uremic dialysis patients admitted to Nanyang Third People's Hospital from April 2021 to April 2025 were selected. Disease uncertainty, health literacy, and anxiety were assessed using the Mishel Uncertainty in Illness Scale (MUIS), the Health Literacy Scale for Chronic Patients (HLSCP), and the Self-Rating Anxiety Scale (SAS), respectively. Pearson correlation analysis was used to examine associations among the variables. Hierarchical regression analysis and Bootstrap resampling were applied to test the mediating effect of disease uncertainty between health literacy and anxiety. Results A total of 127 questionnaires were distributed, and 116 valid questionnaires were returned, yielding an effective response rate of 91.34%. Among the 116 uremic dialysis patients, the total scores were 75.13±18.76 for MUIS, 64.28±10.97 for HLSCP, and 56.82±6.44 for SAS. Pearson correlation analysis showed that the total MUIS score was positively correlated with the total SAS score (P<0.05) and negatively correlated with the total HLSCP score (P<0.05); the total HLSCP score was negatively correlated with the total SAS score (P<0.05). Mediation analysis indicated that disease uncertainty had a partial mediating effect on the relationship between health literacy and anxiety in uremic dialysis patients, accounting for 53.4% of the total effect. Conclusion Disease uncertainty is an important mediating mechanism through which health literacy influences anxiety in uremic dialysis patients. In clinical practice, anxiety symptoms may be alleviated by improving health literacy and reducing disease uncertainty.

Key words: uremia, dialysis, disease uncertainty, health literacy, anxiety, mediating effect

中图分类号:

R692.5

王艳, 杨珩. 疾病不确定感在尿毒症透析患者健康素养与焦虑水平间的中介效应[J]. 临床荟萃, 2026, 41(4): 318-322.

Wang Yan, Yang Heng. Mediating effect of disease uncertainty on the relationship between health literacy and anxiety in uremic dialysis patients[J]. Clinical Focus, 2026, 41(4): 318-322.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.04.005

https://www.lchc.cn/CN/Y2026/V41/I4/318

图/表 4

表1 尿毒症透析患者MUIS、HLSCP、SAS得分

Tab.1 MUIS, HLSCP, and SAS scores in uremic dialysis patients

项目	总分(分)	分数(分)	条目均分(分)
MUIS总分	25~125	75.13±18.76	3.01±0.75
不明确性	11~55	32.19±8.85	2.93±0.80
缺乏澄清	7~35	21.96±6.71	3.14±0.96
信息缺乏	4~20	11.48±3.58	2.87±0.90
不可预测性	3~15	9.27±3.06	3.09±1.02
HLSCP总分	24~120	64.28±10.97	2.68±0.46
信息获取能力	9~45	21.73±4.68	2.41±0.52
交流互动能力	9~45	28.63±6.45	3.18±0.72
改善健康意愿	4~20	10.16±2.71	2.54±0.68
经济支持意愿	2~10	5.04±1.22	2.52±0.61
SAS总分	25~100	56.82±6.44	-

表2 尿毒症透析患者不确定感、健康素养、焦虑的相关性分析

Tab.2 Correlation analysis of uncertainty, health literacy, and anxiety in uremic dialysis patients

变量	SAS总分	MUIS总分	HLSCP总分
SAS总分	1.000	-	-
MUIS总分	0.517^*	1.000	-
HLSCP总分	-0.618^*	-0.592^*	1.000

表3 疾病不确定感的中介效应回归分析

Tab.3 Regression analysis of the mediating effect of disease uncertainty

步骤	因变量	预测变量	β值	标准误	$t$ 值	$P$ 值	调整 $R 2$
步骤1	焦虑	健康素养	-0.601	0.072	-8.352	<0.01	0.374
步骤2	疾病不确定感	健康素养	-0.584	0.065	-8.985	<0.01	0.336
步骤3	焦虑	健康素养	-0.280	0.069	-4.058	<0.01	0.526
		疾病不确定感	0.548	0.062	8.839	<0.01

表3 疾病不确定感的中介效应回归分析

Tab.3 Regression analysis of the mediating effect of disease uncertainty

步骤	因变量	预测变量	β值	标准误	$t$ 值	$P$ 值	调整 $R 2$
步骤1	焦虑	健康素养	-0.601	0.072	-8.352	<0.01	0.374
步骤2	疾病不确定感	健康素养	-0.584	0.065	-8.985	<0.01	0.336
步骤3	焦虑	健康素养	-0.280	0.069	-4.058	<0.01	0.526
		疾病不确定感	0.548	0.062	8.839	<0.01

表4 疾病不确定感中介效应的Bootstrap法检验

Tab.4 Bootstrap test of the mediating effect of disease uncertainty

效应路径	效应值	标准误	$P$ 值	95% $C I$		效应占比
效应路径	效应值	标准误	$P$ 值	下限	上限	效应占比
总效应(c)	-0.601	0.072	<0.01	-0.743	-0.459	100%
直接效应(c')	-0.280	0.069	<0.01	-0.416	-0.144	46.6%
间接效应(a×b)	-0.321	0.051	<0.01	-0.425	-0.227	53.4%

表4 疾病不确定感中介效应的Bootstrap法检验

Tab.4 Bootstrap test of the mediating effect of disease uncertainty

效应路径	效应值	标准误	$P$ 值	95% $C I$		效应占比
效应路径	效应值	标准误	$P$ 值	下限	上限	效应占比
总效应(c)	-0.601	0.072	<0.01	-0.743	-0.459	100%
直接效应(c')	-0.280	0.069	<0.01	-0.416	-0.144	46.6%
间接效应(a×b)	-0.321	0.051	<0.01	-0.425	-0.227	53.4%

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