基于潜在剖面分析的高血压患者自我管理行为与血压控制的关联研究

目的 运用潜在剖面分析了解高血压患者自我管理行为特征，分析其与血压控制的关联。方法 于2016年5~7月在北京市顺义区8个社区卫生服务中心募集595名患者，进行问卷调查（基本信息、自我管理行为）和体格检查（血压测量）。结果 基于潜在剖面分析将患者分为2个类别：行为较差组100人（16.8%），行为较好组495人（83.2%）。两组以吸烟（均分0.15 vs 6.94）、饮酒（均分2.32 vs 6.43）为主要的剖面分类特征。两组在性别（χ²=163.290，P<0.001）、高血压服药年限（Z=-2.567，P=0.010）方面差异有统计学意义，行为较差组以男性、服药年限<5年为主，而较好组以女性、服药年限10~19年为主。Logistic回归分析显示：相对于新农合患者，城镇居民和超转（OR=2.618，95%CI：1.549~4.423）、城镇职工和公费医疗（OR=3.449，95%CI：2.196~5.415）患者血压控制更好；相对于行为较好组患者，较差组患者（OR=0.495，95%CI：0.311~0.788）血压控制更差。结论 高血压患者自我管理行为以吸烟、饮酒为主要剖面分类特征，应提高对男性、服药年限较短患者的自我管理行为干预，加强对新农合患者、自我管理行为较差患者的关注和管理。

Association analysis of self-management behaviors and blood pressure control in patients with hypertension based on latent profile analysis

Objective To investigate the characteristics of self-management behaviors in patients with hypertension based on latent profile analysis (LPA), and to analyze the association between self-management behaviors and blood pressure control. Methods A total of 595 hypertensive patients were enrolled from eight community health service centers in Shunyi District of Beijing. The questionnaire including demographic characteristics and self-management behaviors, and physical examination including blood pressure measurement were used to conduct the survey. Results Patients were divided into two categories based on LPA of self-management behaviors:the worse group including 100 patients (16.8%) and the better group including 495 patients (83.2%). The two groups were mainly profiled by smoking (mean score was 0.15 vs 6.94) and drinking (mean score was 2.32 vs 6.43). And there were significant difference in gender (χ2=163.290, P<0.001) and hypertension medication history (Z=-2.567, P=0.010). The worse group mainly contained male patients and patients with less than 5 years of medication history, while the better group was characterized by female and 10-19 years of medication history. Binary Logistic regression analysis about blood pressure control showed that:compared to patients with New Rural Cooperative Medical Scheme, the blood pressure control was better in patients with Urban Residents Basic Medical Insurance and Ultra Personnel Medical Insurance (OR=2.618, 95% CI:1.549-4.423), and with Socialized medicine and Urban Employees Basic Medical Insurance (OR=3.449, 95% CI:2.196-5.415); compared to patients in the better group, the blood pressure control was poorer in patients of the worse group (OR=0.495, 95% CI:0.311-0.788). Conclusions Self-management behaviors of patients with hypertension are mainly classified by smoking and drinking. Interventions on self-management behaviors should be taken for male patients and for patients with shorter hypertension medication history. The attention and management for patients with New Rural Cooperative Medical Scheme and patients with poor self-management behaviors should be strengthened.