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Article(id=1322929686631817670, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, articleNumber=null, orderNo=null, doi=10.12102/j.issn.1009-6493.2026.14.009, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1753632000000, receivedDateStr=2025-07-28, revisedDate=1777132800000, revisedDateStr=2026-04-26, acceptedDate=null, acceptedDateStr=null, onlineDate=1793340616137, onlineDateStr=2026-10-30, pubDate=1784908800000, pubDateStr=2026-07-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1793340616137, onlineIssueDateStr=2026-10-30, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1793340616137, creator=13701087609, updateTime=1793340616137, updator=13701087609, issue=Issue{id=1322929547464815391, tenantId=1146029695717560320, journalId=1220038315760373764, year='2026', volume='40', issue='14', pageStart='2385', pageEnd='2576', issueExtLink='null', onlineDate='null', pubDate='1784908800000', pubDateStr='2026-07-25', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1793340582958, creator='13701087609', updateTime=1793343111003, updator='13701087609', preIssue=null, nextIssue=null, articleTotal=null, ext={EN=IssueExt(id=1322940150912790807, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1322940150912790808, tenantId=1146029695717560320, journalId=1220038315760373764, issueId=1322929547464815391, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null, downloadFileDto=null}, startPage=2452, endPage=2457, ext={EN=ArticleExt(id=1322929686870892999, articleId=1322929686631817670, tenantId=1146029695717560320, journalId=1220038315760373764, language=EN, title=Developmental trajectories of illness perception and influencing factors in patients with diabetic ketoacidosis, columnId=1220689484526572183, journalTitle=Chinese Nursing Research, columnName=Original Articles, runingTitle=null, highlight=null, articleAbstract=
Objective

To analyze the developmental trajectories of illness perception in patients with diabetic ketoacidosis(DKA) and to analyze the influencing factors.

Methods

A total of 197 hospitalized patients with DKA admitted to our hospital were selected as the study subjects by a convenience sampling method from February 2022 to December 2023.Surveys were conducted at admission,and at 1 month,3 months,and 6 months after admission using a general information questionnaire,the Summary Diabetes Self-Care Activities,the 10-Item Connor-Davidson Resilience Scale,the Brief Illness Perception Questionnaire,and the Hospital Anxiety and Depression Scale.Latent class growth modeling was used to identify the classification of the developmental trajectories of illness perception in patients with DKA.Logistic regression analysis was employed to explore influencing factors.

Results

Illness perception scores of patients with DKA at admission and at 1 month,3 months,and 6 months after admission were 45.78±12.35,40.18±9.27,36.87±7.51,and 36.33±7.44,respectively.Latent class growth modeling identified three distinct developmental trajectories of illness perception in patients with DKA,namely a significant decline group(45 patients,accounting for 22.8%),a decline followed by increase group(90 patients,accounting for 45.7%),and a slow decline group(62 patients,accounting for 31.5%).Logistic regression analysis results showed that educational level,average monthly income,disease severity of DKA,anxiety,depression,diabetes self-management behaviors,and psychological resilience were all influencing factors for the classification of the developmental trajectories of illness perception in patients with DKA(all P<0.05).

Conclusions

The developmental trajectories of illness perception in patients with DKA exhibit group heterogeneity.Healthcare providers should develop targeted intervention strategies based on the influencing factors associated with different classification of the developmental trajectories to improve the illness perception of patients.

, authors=Yajuan XU, Yuan ZHOU, authorsList=Yajuan XU, Yuan ZHOU, authorCompany=null, correspAuthors=Yuan ZHOU, authorNote=null, correspAuthorsNote=null, copyrightStatement=null, copyrightOwner=null, extLink=null, articleAbsUrl=null, sourceXml=null, magXml=null, pdfUrl=null, pdf=null, pdfFileSize=null, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=null, mapNumber=null, fund=null), CN=ArticleExt(id=1322929687562953162, articleId=1322929686631817670, tenantId=1146029695717560320, journalId=1220038315760373764, language=CN, title=糖尿病酮症酸中毒病人疾病感知发展轨迹及影响因素, columnId=1220689484681761433, journalTitle=护理研究, columnName=科研论著, runingTitle=null, highlight=null, articleAbstract=
目的

分析糖尿病酮症酸中毒（DKA）病人疾病感知发展轨迹，并分析其影响因素。

方法

采用便利抽样法，选取2022年2月—2023年12月我院收治的197例DKA住院病人为研究对象。于病人入院时及入院后1、3、6个月采用一般资料调查表、糖尿病自我管理行为量表、心理弹性量表简版、简易疾病感知问卷、医院焦虑抑郁量表进行调查。采用潜类别增长模型识别DKA病人疾病感知发展轨迹类别，并通过Logistic回归分析探究其影响因素。

结果

DKA病人入院时以及入院后1、3、6个月的疾病感知得分分别为（45.78±12.35）分、（40.18±9.27）分、（36.87±7.51）分、（36.33±7.44）分。潜类别增长模型识别出3类DKA病人疾病感知发展轨迹，分别为疾病感知显著降低组（45例，占22.8%）、疾病感知降低升高组（90例，占45.7%）、疾病感知缓慢降低组（62例，占31.5%）。Logistic回归分析结果显示，文化程度、人均月收入、DKA病情严重程度、焦虑、抑郁、糖尿病自我管理行为、心理弹性均是DKA病人疾病感知发展轨迹类别的影响因素（均P<0.05）。

结论

DKA病人的疾病感知发展轨迹具有群体异质性，医护人员应基于不同DKA病人的疾病感知发展轨迹类别影响因素制定针对性干预方案，改善病人疾病感知状况。

, authors=徐亚娟, 周元*, *, authorsList=徐亚娟, 周元, authorCompany=null, correspAuthors=周元, authorNote=

徐亚娟，护师，本科

, correspAuthorsNote=
周元，E-mail:
ZHOU Yuan, E-mail:
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rfNumber=21, rfOrder=20, authorNames=Poulsen K M, Pachana N A, Mcdermott B M, journalName=J Health Psychol, refType=null, unstructuredReference=Poulsen K M,Pachana N A,Mcdermott B M.Health professionals' detection of depression and anxiety in their patients with diabetes:The influence of patient,illness and psychological factors[J].J Health Psychol,2016,21(8):1566-1575., articleTitle=Health professionals' detection of depression and anxiety in their patients with diabetes:The influence of patient,illness and psychological factors, refAbstract=null), Reference(id=1322929693468533248, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, doi=null, pmid=null, pmcid=null, year=2021, volume=29, issue=12, pageStart=934, pageEnd=938, url=null, language=null, rfNumber=22, rfOrder=21, authorNames=韩明月, 张福莲, 张华, journalName=中国慢性病预防与控制, refType=null, unstructuredReference=韩明月,张福莲,张华,等.疾病感知对2型糖尿病患者自我管理行为的影响[J].中国慢性病预防与控制,2021,29(12):934-938., articleTitle=疾病感知对2型糖尿病患者自我管理行为的影响, refAbstract=null), Reference(id=1322929693560807937, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, doi=null, pmid=null, pmcid=null, year=2023, volume=45, issue=21, pageStart=2664, pageEnd=2668, url=null, language=null, rfNumber=23, rfOrder=22, authorNames=莫彬彬, 戴霞, 黎学颖, journalName=广西医学, refType=null, unstructuredReference=莫彬彬,戴霞,黎学颖,等.2型糖尿病患者感知健康能力现状及其影响因素[J].广西医学,2023,45(21):2664-2668., articleTitle=2型糖尿病患者感知健康能力现状及其影响因素, refAbstract=null)], funds=null, companyList=[AuthorCompany(id=1322929687936246219, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, xref=1, ext=[AuthorCompanyExt(id=1322929687944634828, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, companyId=1322929687936246219, language=EN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1The First Affiliated Hospital with Nanjing Medical University, Jiangsu 210029 China), AuthorCompanyExt(id=1322929687953023437, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, companyId=1322929687936246219, language=CN, country=null, province=null, city=null, postcode=null, companyName=null, departmentName=null, remark=1南京医科大学第一附属医院，江苏 210029)])], figs=[ArticleFig(id=1322929690448634339, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, language=EN, label=Figure 1, caption=Trajectory plot of illness perception in patients with DKA, figureFileSmall=iTiJWbVP5N1nppgTAOW2Hg==, figureFileBig=iPqFuVLEhGz9QzKqkYCElQ==, tableContent=null), ArticleFig(id=1322929690725458404, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, language=CN, label=图1, caption=DKA病人疾病感知轨迹图, figureFileSmall=iTiJWbVP5N1nppgTAOW2Hg==, figureFileBig=iPqFuVLEhGz9QzKqkYCElQ==, tableContent=null), ArticleFig(id=1322929690918396389, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, language=EN, label=Table 1, caption=

Fit indices of the LCGM for illness perception in patients with DKA

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICPEntropy类别概率
LMRTBLRT
15 052.0155 112.0005 055.6881.000
24 960.7404 946.7075 010.3330.062<0.0010.8490.772/0.228
34 771.0134 959.6044 820.813<0.001<0.0010.9570.228/0.457/0.315
44 631.7405 002.9404 741.7840.5140.6830.8120.086/0.152/0.203/0.558
55 014.3115 028.9614 773.9840.3670.4260.7840.178/0.213/0.152/0.091/0.365
), ArticleFig(id=1322929691153277414, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, language=CN, label=表1, caption=

DKA病人疾病感知的LCGM拟合指标

, figureFileSmall=null, figureFileBig=null, tableContent=
模型AICBICaBICPEntropy类别概率
LMRTBLRT
15 052.0155 112.0005 055.6881.000
24 960.7404 946.7075 010.3330.062<0.0010.8490.772/0.228
34 771.0134 959.6044 820.813<0.001<0.0010.9570.228/0.457/0.315
44 631.7405 002.9404 741.7840.5140.6830.8120.086/0.152/0.203/0.558
55 014.3115 028.9614 773.9840.3670.4260.7840.178/0.213/0.152/0.091/0.365
), ArticleFig(id=1322929691241357799, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, language=EN, label=Table 2, caption=

Univariate analysis of influencing factors for the classification of developmental trajectories of illness perception in patients with DKA

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类疾病感知显著降低组（n=45）疾病感知降低升高组（n=90）疾病感知缓慢降低组（n=62）统计值P
SDSCA评分（分）47.26±12.5138.12±7.4242.52±9.34F=14.652<0.001
CD-RISC-10评分（分）30.62±5.4225.84±3.9227.96±5.13F=16.042<0.001
文化程度[例（%）]小学及以下15（33.33）52（57.78）23（37.10）
初中或高中9（20.00）24（26.67）15（24.19）χ2=17.947<0.001
专科及以上21（46.67）14（15.56）24（38.71）
人均月收入[例（%）]<1 000元7（15.56）32（35.56）12（19.35）
1 000~3 000元14（31.11）40（44.44）26（41.94）χ2=18.161<0.001
>3 000元24（53.33）18（20.00）24（38.71）
DKA病情严重程度[例（%）]轻度17（37.78）20（22.22）31（50.00）
中度13（28.89）32（35.56）15（24.19）χ2=12.861<0.001
重度15（33.33）38（42.22）16（25.81）
焦虑分量表评分[例（%）]<8分28（62.22）31（34.44）30（48.39）χ2=9.7230.008
≥8分17（37.78）59（65.56）32（51.61）
抑郁分量表评分[例（%）]<8分30（66.67）35（38.89）36（58.06）χ2=10.9380.004
≥8分15（33.33）55（61.11）26（41.94）
), ArticleFig(id=1322929691308466664, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, language=CN, label=表2, caption=

DKA病人疾病感知发展轨迹类别影响因素的单因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量分类疾病感知显著降低组（n=45）疾病感知降低升高组（n=90）疾病感知缓慢降低组（n=62）统计值P
SDSCA评分（分）47.26±12.5138.12±7.4242.52±9.34F=14.652<0.001
CD-RISC-10评分（分）30.62±5.4225.84±3.9227.96±5.13F=16.042<0.001
文化程度[例（%）]小学及以下15（33.33）52（57.78）23（37.10）
初中或高中9（20.00）24（26.67）15（24.19）χ2=17.947<0.001
专科及以上21（46.67）14（15.56）24（38.71）
人均月收入[例（%）]<1 000元7（15.56）32（35.56）12（19.35）
1 000~3 000元14（31.11）40（44.44）26（41.94）χ2=18.161<0.001
>3 000元24（53.33）18（20.00）24（38.71）
DKA病情严重程度[例（%）]轻度17（37.78）20（22.22）31（50.00）
中度13（28.89）32（35.56）15（24.19）χ2=12.861<0.001
重度15（33.33）38（42.22）16（25.81）
焦虑分量表评分[例（%）]<8分28（62.22）31（34.44）30（48.39）χ2=9.7230.008
≥8分17（37.78）59（65.56）32（51.61）
抑郁分量表评分[例（%）]<8分30（66.67）35（38.89）36（58.06）χ2=10.9380.004
≥8分15（33.33）55（61.11）26（41.94）
), ArticleFig(id=1322929691597873641, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, language=EN, label=Table 3, caption=

Multivariate analysis of influencing factors for the classification of the developmental trajectories of illness perception in patients with DKA

, figureFileSmall=null, figureFileBig=null, tableContent=
组别变量回归系数标准误Wald χ2值POR值95%CI
疾病感知降低升高组①常量-3.1840.69421.055<0.001
文化程度 小学及以下1.0580.5264.0510.0442.882[1.028，8.078]
初中及高中-0.0140.5650.0010.9800.986[0.326，2.983]
人均月收入 <1 000元2.1900.63112.0600.0018.934[2.596，30.748]
1 000~3 000元0.5690.5890.9350.3341.767[0.557，5.603]
DKA病情严重程度 重度0.4850.5470.7870.3751.624[0.556，4.744]
中度-0.2340.5340.1930.6610.791[0.278，2.253]
焦虑分量表评分1.0000.4484.9740.0262.719[1.129，6.548]
抑郁分量表评分1.1890.4826.0850.0143.283[1.277，8.441]
SDSCA评分-0.1650.03423.593<0.0010.848[0.793，0.906]
CD-RISC-10评分-0.2600.06914.196<0.0010.771[0.673，0.883]
疾病感知降低升高组②常量-2.1460.52916.450<0.001
文化程度 小学及以下0.9740.4574.5320.0332.648[1.080，6.490]
初中及高中0.2620.4560.3310.5651.300[0.532，3.176]
人均月收入 <1 000元1.3170.5176.5030.0113.733[1.356，10.276]
1 000~3 000元0.5680.4641.4990.2211.764[0.711，4.378]
DKA病情严重程度 重度1.0840.4665.4000.0202.956[1.185，7.375]
中度0.0430.4610.0090.9261.044[0.423，2.577]
焦虑分量表评分0.2880.3880.5500.4581.333[0.623，2.851]
抑郁分量表评分0.6490.3752.9960.0831.914[0.918，3.993]
SDSCA评分-0.0610.0237.2220.0070.941[0.901，0.984]
CD-RISC-10评分-0.0810.0413.9340.0470.922[0.851，0.999]
), ArticleFig(id=1322929691711119850, tenantId=1146029695717560320, journalId=1220038315760373764, articleId=1322929686631817670, language=CN, label=表3, caption=

DKA病人疾病感知发展轨迹类别影响因素的多因素分析

, figureFileSmall=null, figureFileBig=null, tableContent=
组别变量回归系数标准误Wald χ2值POR值95%CI
疾病感知降低升高组①常量-3.1840.69421.055<0.001
文化程度 小学及以下1.0580.5264.0510.0442.882[1.028，8.078]
初中及高中-0.0140.5650.0010.9800.986[0.326，2.983]
人均月收入 <1 000元2.1900.63112.0600.0018.934[2.596，30.748]
1 000~3 000元0.5690.5890.9350.3341.767[0.557，5.603]
DKA病情严重程度 重度0.4850.5470.7870.3751.624[0.556，4.744]
中度-0.2340.5340.1930.6610.791[0.278，2.253]
焦虑分量表评分1.0000.4484.9740.0262.719[1.129，6.548]
抑郁分量表评分1.1890.4826.0850.0143.283[1.277，8.441]
SDSCA评分-0.1650.03423.593<0.0010.848[0.793，0.906]
CD-RISC-10评分-0.2600.06914.196<0.0010.771[0.673，0.883]
疾病感知降低升高组②常量-2.1460.52916.450<0.001
文化程度 小学及以下0.9740.4574.5320.0332.648[1.080，6.490]
初中及高中0.2620.4560.3310.5651.300[0.532，3.176]
人均月收入 <1 000元1.3170.5176.5030.0113.733[1.356，10.276]
1 000~3 000元0.5680.4641.4990.2211.764[0.711，4.378]
DKA病情严重程度 重度1.0840.4665.4000.0202.956[1.185，7.375]
中度0.0430.4610.0090.9261.044[0.423，2.577]
焦虑分量表评分0.2880.3880.5500.4581.333[0.623，2.851]
抑郁分量表评分0.6490.3752.9960.0831.914[0.918，3.993]
SDSCA评分-0.0610.0237.2220.0070.941[0.901，0.984]
CD-RISC-10评分-0.0810.0413.9340.0470.922[0.851，0.999]
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糖尿病酮症酸中毒病人疾病感知发展轨迹及影响因素
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徐亚娟 , 周元 *, *
护理研究 | 科研论著 2026,40(14): 2452-2457
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护理研究 |科研论著 2026 , 40 (14) : 2452 -2457
糖尿病酮症酸中毒病人疾病感知发展轨迹及影响因素
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徐亚娟, 周元*, *
作者信息
  • 1南京医科大学第一附属医院，江苏 210029
通讯作者:
周元，E-mail:
ZHOU Yuan, E-mail:
作者简介:

徐亚娟，护师，本科

Developmental trajectories of illness perception and influencing factors in patients with diabetic ketoacidosis
Yajuan XU, Yuan ZHOU
Affiliations
  • 1The First Affiliated Hospital with Nanjing Medical University, Jiangsu 210029 China
出版时间: 2026-07-25 doi: 10.12102/j.issn.1009-6493.2026.14.009
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摘要
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目的

分析糖尿病酮症酸中毒（DKA）病人疾病感知发展轨迹，并分析其影响因素。

方法

采用便利抽样法，选取2022年2月—2023年12月我院收治的197例DKA住院病人为研究对象。于病人入院时及入院后1、3、6个月采用一般资料调查表、糖尿病自我管理行为量表、心理弹性量表简版、简易疾病感知问卷、医院焦虑抑郁量表进行调查。采用潜类别增长模型识别DKA病人疾病感知发展轨迹类别，并通过Logistic回归分析探究其影响因素。

结果

DKA病人入院时以及入院后1、3、6个月的疾病感知得分分别为（45.78±12.35）分、（40.18±9.27）分、（36.87±7.51）分、（36.33±7.44）分。潜类别增长模型识别出3类DKA病人疾病感知发展轨迹，分别为疾病感知显著降低组（45例，占22.8%）、疾病感知降低升高组（90例，占45.7%）、疾病感知缓慢降低组（62例，占31.5%）。Logistic回归分析结果显示，文化程度、人均月收入、DKA病情严重程度、焦虑、抑郁、糖尿病自我管理行为、心理弹性均是DKA病人疾病感知发展轨迹类别的影响因素（均P<0.05）。

结论

DKA病人的疾病感知发展轨迹具有群体异质性，医护人员应基于不同DKA病人的疾病感知发展轨迹类别影响因素制定针对性干预方案，改善病人疾病感知状况。

糖尿病酮症酸中毒  /  疾病感知  /  发展轨迹  /  潜类别增长模型  /  影响因素
Objective

To analyze the developmental trajectories of illness perception in patients with diabetic ketoacidosis(DKA) and to analyze the influencing factors.

Methods

A total of 197 hospitalized patients with DKA admitted to our hospital were selected as the study subjects by a convenience sampling method from February 2022 to December 2023.Surveys were conducted at admission,and at 1 month,3 months,and 6 months after admission using a general information questionnaire,the Summary Diabetes Self-Care Activities,the 10-Item Connor-Davidson Resilience Scale,the Brief Illness Perception Questionnaire,and the Hospital Anxiety and Depression Scale.Latent class growth modeling was used to identify the classification of the developmental trajectories of illness perception in patients with DKA.Logistic regression analysis was employed to explore influencing factors.

Results

Illness perception scores of patients with DKA at admission and at 1 month,3 months,and 6 months after admission were 45.78±12.35,40.18±9.27,36.87±7.51,and 36.33±7.44,respectively.Latent class growth modeling identified three distinct developmental trajectories of illness perception in patients with DKA,namely a significant decline group(45 patients,accounting for 22.8%),a decline followed by increase group(90 patients,accounting for 45.7%),and a slow decline group(62 patients,accounting for 31.5%).Logistic regression analysis results showed that educational level,average monthly income,disease severity of DKA,anxiety,depression,diabetes self-management behaviors,and psychological resilience were all influencing factors for the classification of the developmental trajectories of illness perception in patients with DKA(all P<0.05).

Conclusions

The developmental trajectories of illness perception in patients with DKA exhibit group heterogeneity.Healthcare providers should develop targeted intervention strategies based on the influencing factors associated with different classification of the developmental trajectories to improve the illness perception of patients.

diabetic ketoacidosis  /  illness perception  /  developmental trajectory  /  latent class growth model  /  influencing factors
徐亚娟, 周元. 糖尿病酮症酸中毒病人疾病感知发展轨迹及影响因素. 护理研究, 2026 , 40 (14) : 2452 -2457 . DOI: 10.12102/j.issn.1009-6493.2026.14.009
Yajuan XU, Yuan ZHOU. Developmental trajectories of illness perception and influencing factors in patients with diabetic ketoacidosis[J]. Chinese Nursing Research, 2026 , 40 (14) : 2452 -2457 . DOI: 10.12102/j.issn.1009-6493.2026.14.009
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糖尿病是一种以血糖代谢紊乱为主要特征的代谢性疾病，2019年全球糖尿病病人约为4.63亿例，其中我国约为1.16亿例；预计到2045年，全球糖尿病病人将增至7亿例，糖尿病已成为继心血管和肿瘤疾病之后的第三大慢性病[1]。糖尿病酮症酸中毒（diabetic ketoacidosis，DKA）是糖尿病病人的常见并发症之一，在1型糖尿病病人中的患病率约为3%，也是糖尿病致死的主要原因之一[2]。已有研究表明，DKA病人的疾病控制应以系统化管理为主，而非传统意义上的临床治疗[3]。糖尿病病人的生活习惯和自我管理能力是防控DKA的关键，同时，DKA病人的疾病感知也在很大程度上影响着病人的病情及预后[4]。疾病感知是指病人根据自身对疾病的了解和经验，对当前病症进行分析和评价的过程[5]。在此过程中，病人会调节自己的情绪反应，并通过改变疾病应对策略影响临床治疗效果。已有研究结果显示，不同个体心理弹性和自我管理能力会使病人在经历创伤事件时产生不同类型的疾病感知轨迹[6-7]。目前，对糖尿病病人疾病感知因素的研究多局限于群体横断面调查，对DKA病人疾病感知水平的连续观测较少[8]。本研究拟对DKA病人的疾病感知水平进行追踪报道，通过潜类别增长模型（latent class growth model，LCGM）识别DKA病人的疾病感知发展轨迹，并探究其影响因素，以期为临床及医务人员制定和精准实施护理方案提供参考。
1　对象与方法
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1.1　研究对象
采用便利抽样法，选取2022年2月—2023年12月我院收治的197例DKA住院病人为研究对象。纳入标准：1）糖尿病符合《中国2型糖尿病防治指南(2020年版)》[9]中相关诊断标准；2）DKA符合《中国高血糖危象诊断与治疗指南》[10]中相关诊断标准；3）年龄≥18岁；4）临床资料齐全；5）顺利完成随访；6）自愿参与本研究。排除标准：1）妊娠糖尿病；2）精神异常，无法正常沟通；3）无法配合量表测试；4）合并恶性肿瘤。根据样本量计算公式计算样本量：N=[维度数×（30~35）]×[1+（10%~15%）][11]。本研究涉及多个量表，为确保样本量充足，选取维度数量多的量表维度数，糖尿病自我管理行为量表（Summary Diabetes Self-Care Activities，SDSCA）共5个维度，故至少需要纳入165例病人。本研究已通过南京医科大学第一附属医院伦理委员会批准（编号：2021-SR-028）。
1.2　调查工具
1.2.1　一般资料调查表
由研究者设计，包括性别、年龄、体质指数、居住地、文化程度、人均月收入、家族史、婚姻状况、职业状态、是否采用胰岛素治疗、DKA病情严重程度等，其中DKA病情严重程度参考既往相关文献[12]，根据入院时的动脉血气分析检测结果划分，将pH>7.2~7.3评为轻度DKA，>7.1~7.2评为中度DKA，pH≤7.1评为重度DKA。
1.2.2　SDSCA
由Toobert等[13]修订，包括特殊饮食、一般饮食、血糖监测、足部护理、体育锻炼5个维度，共11个条目，采用Likert 7级评分法，以糖尿病病人过去1周内自我监测管理天数评分，单个维度评分为各维度内部条目总分均值，SDSCA总分为各维度均分总和，得分越高表示受试者的自我管理行为越好。在本研究中该量表的Cronbach's α系数为0.815。
1.2.3　心理弹性量表简版（10-Item Connor-Davidson Resilience Scale，CD-RISC-10）
由张丹梅等[14]汉化，量表为单维度，共10个条目，采用Likert 5级评分法，从“从来不”至“一直如此”依次计0~4分，总分0~40分，得分越高表示受试者心理弹性越强。本研究中该量表的Cronbach's α系数为0.814。
1.2.4　简易疾病感知问卷
由李艳艳[15]汉化，包含9个条目，条目1~条目8采用Likert 10级评分法，条目9不计入总分，总分<16分提示受试者为轻度疾病感知，16~31分提示受试者为轻中度疾病感知，>31~48分提示受试者为中度疾病感知，>48~64分提示受试者为中重度疾病感知，>64分提示受试者为重度疾病感知。在本研究中该量表的Cronbach's α系数为0.831。
1.2.5　医院焦虑抑郁量表
由Zigmond等[16]编制，包含焦虑、抑郁2个分量表，每个分量表均由7个条目组成，采用Likert 4级评分法，分量表总分均为0~21分，得分越高表示受试者焦虑或抑郁症状越严重，得分≥8分表示受试者存在焦虑或抑郁症状。在本研究中焦虑和抑郁分量表的Cronbach's α系数分别为0.882和0.926。
1.3　资料收集方法
成立调查小组，分别于病人入院时进行一般资料SDSCA、CD-RISC-10、医院焦虑抑郁量表及简易疾病感知问卷调查，于入院后1、3、6个月通过简易疾病感知问卷对DKA病人进行随访调查。调查前向病人解释研究目的和研究意义，随访调查期间针对回院复查或住院的病人以面对面的形式进行资料收集，针对出院病人通过微信或电话进行随访调查，承诺相关调查结果仅用于本研究，且对相关内容进行保密处理。入院时发放问卷220份，入院时以及入院后1、3、6个月依次有220、217、208、197例病人完成问卷，累计23例病人失访，病人失访率为10.45%，问卷有效回收率为89.55%，符合样本计算需求。
1.4　统计学方法
采用SPSS 25.0软件分析数据，符合正态分布的定量资料以均数±标准差（x±s）表示，组间比较采用方差分析；定性资料以频数及百分比（%）表示，组间比较采用χ2检验。采用LCGM分析DKA病人疾病感知的发展轨迹，方差设定为0，从单类别模型逐渐增加类别数，根据模型拟合指标选择最佳模型，采用艾凯克信息准则（AIC）、贝叶斯信息准则（BIC）以及样本校正的BIC（aBIC）评估模型拟合度，统计值越小表示模型拟合度越好；采用信息熵（Entropy）评估模型分类标准性；采用Bootstrap似然比检验（Bootstrap likelihood ratio test，BLRT）和罗-梦戴尔-鲁本校正似然比检验（Lo-Mendell-Rubin test，LMRT）比较模型拟合差异，有统计学意义说明第k个模型的适配度优于第k-1个模型；采用GraphPad Prism 8.0软件绘制发展轨迹图。采用Logistic回归分析探讨影响因素。以P<0.05为有统计学意义。
2　结果
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2.1　DKA病人疾病感知发展轨迹
197例DKA病人入院时以及入院后1、3、6个月的疾病感知得分分别为（45.78±12.35）分、（40.18±9.27）分、（36.87±7.51）分、（36.33±7.44）分，DKA病人不同时间的疾病感知得分比较，差异有统计学意义（F=93.246，P<0.01）。以DKA病人不同时间的疾病感知得分为观测指标，采用LCGM进行分析，当模型类别由1个增加至2个时，AIC、BIC、aBIC值减小，但类别为2个时LMRT无统计学意义（P>0.05）；当模型类别数为3个时，AIC、BIC、aBIC值较小，Entropy最大（为0.957），且LMRT和BLRT均有统计学意义（均P<0.05），综合对比模型拟合结果，最终确定模型3拟合效果最佳，见表1。
2.2　DKA病人疾病感知发展轨迹特征及命名
根据LCGM拟合结果将DKA病人的疾病感知分为3类，轨迹1在入院时的疾病感知处于较高水平，且在后续随访调查中，疾病感知水平有明显降低趋势，因而命名为“疾病感知显著降低组”，其共45例DKA病人，占22.8%（45/197）；轨迹2在入院时的疾病感知处于中等水平，但在后续随访调查中，疾病感知水平略微降低后呈升高趋势，因而命名为“疾病感知降低升高组”，其共90例DKA病人，占45.7%（90/197）；轨迹3在基线调查时的疾病感知水平低于轨迹1和轨迹2，后续疾病感知水平呈降低趋势，但降低程度小于轨迹1，因而命名为“疾病感知缓慢降低组”，其共62例DKA病人，占31.5%（62/197）。见图1。
2.3　DKA病人疾病感知发展轨迹类别影响因素的单因素分析
197例DKA病人SDSCA评分为（41.59±10.13）分，CD-RISC-10评分为（27.61±4.81）分。DKA病人疾病感知发展轨迹影响因素的单因素分析结果见表2。
2.4　DKA病人疾病感知发展轨迹类别影响因素的多因素分析
以DKA病人疾病感知发展轨迹为因变量，以单因素分析中差异有统计学意义的变量为自变量，平行性检验P=0.035，故行无序多分类Logistic回归分析，结果显示，文化程度、人均月收入、DKA病情严重程度、焦虑、抑郁、糖尿病自我管理行为、心理弹性均是DKA病人疾病感知发展轨迹类别的影响因素（均P<0.05），见表3。
3　讨论
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3.1　DKA病人疾病感知发展轨迹
自我调节理论指出，个体的疾病感知水平可随病情进展和治疗不断变化[17]。本研究纳入的197例DKA病人疾病感知于入院时处于较高水平，但随着病情缓解总体呈下降趋势。且本研究结果显示，不同发展轨迹病人对疾病的感知水平存在差异，DKA病人的疾病感知存在群体异质性，共识别3条发展轨迹，即疾病感知显著降低组（45例，占22.8%）、疾病感知降低升高组（90例，占45.7%）、疾病感知缓慢降低组（62例，占31.5%），其中，疾病感知显著降低组和疾病感知缓慢降低组病人共107例，占54.3%，高于疾病感知降低升高组，说明随着时间推移多数DKA病人的疾病感知水平可逐渐改善，但仍有少数DKA病人的疾病感知处于高表达状态，医务人员应将疾病感知降低升高组病人列为重点关注对象，识别其特征，并制订相应的护理方案，以降低其疾病感知表达。
3.2　DKA病人疾病感知发展轨迹类别的影响因素
3.2.1　人口学资料与疾病特征相关因素
本研究结果显示，与疾病感知显著降低组比较，小学及以下文化程度、人均月收入<1 000元、焦虑分量表评分≥8分、抑郁分量表评分≥8分的DKA病人归为疾病感知降低升高组的概率相对较大（均P<0.05）；与疾病感知缓慢降低组比较，小学及以下文学程度、人均月收入<1 000元、DKA病情严重程度为重度的DKA病人归为疾病感知降低升高组的概率相对较大（均P<0.05）。分析原因可能为：1）已有研究发现，文化程度较低者往往表现出较高的疾病感知水平[18]。文化程度较低者可能更易缺乏与疾病相关的健康知识，导致病人对自身不适和疾病症状更为敏感，故而疾病感知水平增高。建议医务人员加强健康教育，提高病人对疾病及相关症状的了解水平，以降低疾病感知表达。2）高月等[19]研究后发现，老年慢性病病人人均月收入与其疾病感知变化水平密切相关，人均月收入较低者疾病感知水平普遍较高。这可能是由于DKA病人需要长期服药并进行定期检查以控制病情，而低收入水平者的经济负担相对较重，因而对自身健康状况的不良变化警惕性更高，疾病感知水平相对较高。3）徐芳等[20]研究发现，糖尿病视网膜病变病人焦虑、抑郁水平与其疾病感知水平密切相关。焦虑和抑郁是影响糖尿病病人心理健康的常见因素，糖尿病病人抑郁发病率可达57%[21]，焦虑和抑郁病人多伴有消极的情绪和思维模式，可能会导致病人对治疗效果产生怀疑，并加剧对疾病症状的过度关注和强化，从而促使病人的疾病感知水平增高。4）DKA病情严重程度为重度的病人疾病感知水平更高，原因可能为重度DKA病人的病情相对较严重，其血糖水平较高和体内酮体产生过多均可引起代谢紊乱和酸中毒等严重并发症，因而病人对病情变化和相关症状的感知更为持续。对此，医务人员应加强对重度DKA病人的监测和关注，及时发现并处理疾病变化。建议临床治疗期间医务人员多关注文化程度较低、人均月收入较低、焦虑和抑郁水平较高以及重度DKA的病人，及时评估其疾病感知水平并相应调整护理干预方案，做好健康宣教和随访工作，以改善其疾病感知状况，提高治疗效果和生活质量。
3.2.2　糖尿病自我管理行为、心理弹性
本研究结果显示，与疾病感知降低升高组比较，SDSCA评分和CD-RISC-10评分较高的DKA病人归为疾病感知显著降低组、疾病感知缓慢降低组的概率相对较大（均P<0.05），即糖尿病自我管理行为较好、心理弹性较强的DKA病人疾病感知水平较低。具备良好自我管理能力的DKA病人往往对疾病的认识和理解也更为深刻，而自我管理能力不佳的病人可能对疾病的认知不足，导致疾病感知水平较高[22]。心理弹性较强的病人往往能够良好地适应和调整自己的情绪和态度，以应对疾病带来的挑战和困难[23]，而心理弹性不佳的病人可能更易受到疾病相关症状的影响，促使病人更加重视症状变化，导致疾病感知水平升高。建议医务人员早期评估病人的自我管理能力和心理弹性，识别自我管理能力和心理弹性不佳者，并开展个体化护理干预方案，以提高病人心理弹性和自我管理能力，改善其疾病感知状况。
4　小结
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本研究通过LCGM识别出DKA病人的疾病感知存在3类发展轨迹，表明DKA病人疾病感知存在群体异质性，且多因素分析结果显示，文化程度、人均月收入、DKA病情严重程度、焦虑、抑郁、糖尿病自我管理行为、心理弹性均是DKA病人疾病感知发展轨迹类别的影响因素。医务人员可结合DKA病人的人口学资料和疾病特征识别高疾病感知病人，并预测其疾病感知动态变化轨迹，根据相关影响因素制定个性化的干预措施，以改善病人的疾病感知。本研究样本量较小且为单中心研究，随访时间较短，未来可考虑开展多中心、大样本研究，进一步验证DKA病人的疾病感知轨迹变化特征，以期为临床提供更可靠的研究结果。

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2026年第40卷第14期
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doi: 10.12102/j.issn.1009-6493.2026.14.009
  • 接收时间：2025-07-28
  • 首发时间：2026-10-30
  • 出版时间：2026-07-25
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  • 收稿日期：2025-07-28
  • 修回日期：2026-04-26
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    1南京医科大学第一附属医院，江苏 210029

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周元，E-mail:
ZHOU Yuan, E-mail:
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2种不同金属材料的力学参数
科
Family		 属数
Number of
genus		 种数
Number of
species		 占总种数比例
Percentage of
total species (%)		 属
Genus		 种数
Number of
species		 占总种数比例
Percentage of total
species (%)
鹅膏菌科Amanitaceae 2 11 5.26 鹅膏菌属 Amanita 10 4.78
小菇科 Mycenaceae 2 12 5.74 丝盖伞属 Inocybe 5 2.39
多孔菌科 Polyporaceae 8 14 6.70 蜡蘑属 Laccaria 5 2.39
红菇科 Russulaceae 3 23 11.00 小皮伞属 Marasmius 6 2.87
小菇属 Mycena 11 5.26
光柄菇属 Pluteus 5 2.39
红菇属 Russula 17 8.13
栓菌属 Trametes 5 2.39
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