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Article(id=1240375118111764903, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, articleNumber=null, orderNo=null, doi=10.20043/j.cnki.MPM.202311331, pmid=null, cstr=null, oa=null, hot=null, price=null, onlineType=0, articleFormat=0, articleType=null, articleTypeStr=null, receivedDate=1700064000000, receivedDateStr=2023-11-16, revisedDate=null, revisedDateStr=null, acceptedDate=null, acceptedDateStr=null, onlineDate=1773658073213, onlineDateStr=2026-03-16, pubDate=1711296000000, pubDateStr=2024-03-25, doiRegisterDate=null, doiRegisterDateStr=null, onlineIssueDate=1773658073213, onlineIssueDateStr=2026-03-16, onlineJustAcceptDate=null, onlineJustAcceptDateStr=null, onlineFirstDate=null, onlineFirstDateStr=null, sourceXml=null, magXml=null, createTime=1773658073213, creator=13701087609, updateTime=1773658073213, updator=13701087609, issue=Issue{id=1240375105386238038, tenantId=1146029695717560320, journalId=1227665162245664772, year='2024', volume='51', issue='6', pageStart='961', pageEnd='1152', issueExtLink='null', onlineDate='null', pubDate='null', beforeIssueId=null, nextIssueId=null, price=null, status=1, issueComplete=1, articleOrder=1, issueType=-1, specialIssue=null, createTime=1773658070179, creator=13701087609, updateTime=1773658539618, updator=13701087609, preIssue=null, nextIssue=null, ext={EN=IssueExt(id=1240377074414833974, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=EN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=), CN=IssueExt(id=1240377074414833975, tenantId=1146029695717560320, journalId=1227665162245664772, issueId=1240375105386238038, language=CN, specialIssueTitle=, coverIllustrator=null, specialIssueEditor=, specialIssueAbout=)}, issueFiles=null}, startPage=974, endPage=979, ext={EN=ArticleExt(id=1240375119533633971, articleId=1240375118111764903, tenantId=1146029695717560320, journalId=1227665162245664772, language=EN, title=Relationship between chronic pain degree and cognitive function in the elderly in Nanshan Pastoral area of Xinjiang: the chain mediating role of depression and frailty, columnId=1228016567443718970, journalTitle=Modern Preventive Medicine, columnName=Epidemiology and Statistical Methods Advances, runingTitle=null, highlight=null, articleAbstract=
Objective

To investigate the prevalence of chronic pain in the elderly in Nanshan Pastoral area of Xinjiang, explore the influence of chronic pain degree on cognitive function, and the mediating role of depression and frailty.

Methods

From June 2022 to February 2023, 1 045 elderly patients ≥60 in Nanshan Pastoral area of Xinjiang were selected by multi-stage random cluster sampling method. The General Information Questionnaire, Pain Numerical Rating Scale, Geriatric Depression Assessment Scale, Tilburg Frailty Scale and Montreal Cognitive Assessment Scale were used to conduct the questionnaire survey.

Results

The prevalence rate of chronic pain in the elderly in Nanshan pastoral area of Xinjiang was 67.27% (703/1 045). The degree of chronic pain was positively correlated with depression and frailty (r=0.472, 0.512, P<0.01), and negatively correlated with cognitive function (r=-0.432, P<0.01). Depression and frailty had significant mediating effect between chronic pain degree and cognitive function. The intermediate effects were -0.134 (95% CI:-0.194--0.074) and -0.145 (95% CI: -0.193--0.101), respectively. The mediating effect of depression-debilitation chain was also significant, and the mediating effect size was -0.121 (95% CI:-0.165--0.083). The total indirect effect of depression and frailty on the degree of chronic pain and cognitive function was -0.400, accounting for 53.33% of the total effect.

Conclusion

The degree of chronic pain not only directly affects the cognitive function of the elderly in Nanshan pastoral area of Xinjiang, but also indirectly affects the cognitive function through the independent mediating effect of depression and frailty and the chain mediating effect of depression and frailty.

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目的

了解新疆南山牧区老年人慢性疼痛患病情况，探究慢性疼痛程度对认知功能的影响，以及抑郁和衰弱在其中的中介作用。

方法

于2022年6月至2023年2月采用多阶段随机整群抽样法抽取新疆南山牧区1 045例≥60岁的老年人作为研究对象。采用一般资料调查表、疼痛数字评定量表、老年抑郁评估量表、Tilburg衰弱量表、蒙特利尔认知评估量表进行问卷调查。

结果

新疆南山牧区老年人慢性疼痛患病率为67.27%（703/1 045）。慢性疼痛程度与抑郁、衰弱呈正相关（r=0.472、0.512, P<0.01），与认知功能呈负相关（r=-0.432, P<0.01）；抑郁和衰弱在慢性疼痛程度和认知功能之间中介效应显著，中介效应量分别为-0.134（95% CI:-0.194～-0.074）、-0.145（95% CI: -0.193～-0.101）；且抑郁-衰弱的链式中介效应也显著，中介效应量为-0.121（95% CI:-0.165～-0.083）。抑郁和衰弱在慢性疼痛程度与认知功能间的总间接效应值为-0.400，占总效应的53.33%。

结论

慢性疼痛程度不仅直接影响新疆南山牧区老年人的认知功能，还通过抑郁和衰弱的独立中介作用以及抑郁-衰弱的链式中介效应间接影响认知功能。

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由淑萍，E-mail：
, copyrightStatement=本刊刊出的所有文章不代表中华预防医学会和本刊编委会的观点，除非特别声明。, copyrightOwner=中华预防医学会和四川大学华西公共卫生学院, extLink=null, articleAbsUrl=null, sourceXml=jgzKzODjhnlmCHwtzpswcw==, magXml=PNiez18X/NBHN9dqxHUw/Q==, pdfUrl=null, pdf=FrILZ6kBhru2j8IGuTOh1g==, pdfFileSize=621327, pdfExtLink=null, richHtmlUrl=null, mobilePdfUrl=null, reviewReport=null, pdfFirstPage=null, abstractGraph=null, abstractGraphContent=null, abstractVideo=null, citation=null, cebUrl=null, magXmlContent=ot/2QyZGraKM3BSOQyNQEg==, mapNumber=null, authorCompany=null, fund=null, authors=

宋晓薇（1991—），女，硕士在读，研究方向：社区护理学

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宋晓薇（1991—），女，硕士在读，研究方向：社区护理学

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宋晓薇（1991—），女，硕士在读，研究方向：社区护理学

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Difference analysis of chronic pain degree and depression in the elderly in different conditions in Nanshan Pastoral area (n=1 045)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别项目n(%)慢性疼痛程度抑郁
得分Z（H）值P值得分Z（H）值P值
性别男535（51.20）3.0（0.0，5.0）-1.2400.2155.0（3.0，7.0）-1.8700.061
女510（48.80）3.0（0.0，5.0）5.0（3.0，8.0）
年龄（岁）60～69459（43.92）3.0（0.0，4.0）20.789a<0.0014.0（3.0，7.0）17.595a<0.001
70～79409（39.14）3.0（0.0，5.0）6.0（3.0，8.0）
≥80177（16.94）4.0（0.0，7.0）5.0（3.0，8.0）
文化程度文盲310（29.67）3.5（0.0，5.0）10.532a0.0055.0（3.0，8.0）7.707a0.021
小学475（45.45）3.0（0.0，5.0）5.0（3.0，7.0）
初中及以上260（24.88）3.0（0.0，5.0）5.0（3.0，7.0）
婚姻状态在婚825（78.95）3.0（0.0，5.0）-1.2570.2095.0（3.0，7.0）-1.5700.117
非在婚220（21.05）3.0（0.0，5.0）5.0（3.0，8.0）
), ArticleFig(id=1240746304586969699, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=CN, label=表1, caption=

南山牧区老年人慢性疼痛程度、抑郁在不同特征上的差异性分析（n=1 045）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别项目n(%)慢性疼痛程度抑郁
得分Z（H）值P值得分Z（H）值P值
性别男535（51.20）3.0（0.0，5.0）-1.2400.2155.0（3.0，7.0）-1.8700.061
女510（48.80）3.0（0.0，5.0）5.0（3.0，8.0）
年龄（岁）60～69459（43.92）3.0（0.0，4.0）20.789a<0.0014.0（3.0，7.0）17.595a<0.001
70～79409（39.14）3.0（0.0，5.0）6.0（3.0，8.0）
≥80177（16.94）4.0（0.0，7.0）5.0（3.0，8.0）
文化程度文盲310（29.67）3.5（0.0，5.0）10.532a0.0055.0（3.0，8.0）7.707a0.021
小学475（45.45）3.0（0.0，5.0）5.0（3.0，7.0）
初中及以上260（24.88）3.0（0.0，5.0）5.0（3.0，7.0）
婚姻状态在婚825（78.95）3.0（0.0，5.0）-1.2570.2095.0（3.0，7.0）-1.5700.117
非在婚220（21.05）3.0（0.0，5.0）5.0（3.0，8.0）
), ArticleFig(id=1240746304687633006, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=EN, label=Table 2, caption=

Difference analysis of frailty and cognitive function of the elderly in different conditions in Nanshan Pastoral area(n=1 045)

, figureFileSmall=null, figureFileBig=null, tableContent=
类别项目n(%)衰弱认知功能
得分Z（H）值P值得分Z（H）值P值
性别男535（51.20）4.0（3.0，6.0）-0.3880.69822.0（19.0，26.0）-0.3590.720
女510（48.80）4.0（3.0，6.0）22.0（19.0，26.0）
年龄（岁）60～69459（43.92）4.0（3.0，5.0）19.370a<0.00123.0（19.0，26.0）12.709a0.002
70～79409（39.14）5.0（3.0，6.0）21.0（18.0，25.0）
≥80177（16.94）5.0（3.0，7.0）21.0（19.0，26.0）
文化程度文盲310（29.67）5.0（3.0，7.0）14.386a0.00121.0（18.8，25.3）7.494a0.024
小学475（45.45）4.0（3.0，6.0）22.0（19.0，26.0）
初中及以上260（24.88）4.0（2.0，6.0）22.0（19.0，26.0）
婚姻状态在婚825（78.95）4.0（3.0，6.0）-1.4990.13422.0（18.0，26.0）-0.8930.372
非在婚220（21.05）4.5（3.0，7.0）22.0（19.0，26.0）
), ArticleFig(id=1240746304809267832, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=CN, label=表2, caption=

南山牧区老年人衰弱、认知功能在不同特征上的差异性分析（n=1 045）

, figureFileSmall=null, figureFileBig=null, tableContent=
类别项目n(%)衰弱认知功能
得分Z（H）值P值得分Z（H）值P值
性别男535（51.20）4.0（3.0，6.0）-0.3880.69822.0（19.0，26.0）-0.3590.720
女510（48.80）4.0（3.0，6.0）22.0（19.0，26.0）
年龄（岁）60～69459（43.92）4.0（3.0，5.0）19.370a<0.00123.0（19.0，26.0）12.709a0.002
70～79409（39.14）5.0（3.0，6.0）21.0（18.0，25.0）
≥80177（16.94）5.0（3.0，7.0）21.0（19.0，26.0）
文化程度文盲310（29.67）5.0（3.0，7.0）14.386a0.00121.0（18.8，25.3）7.494a0.024
小学475（45.45）4.0（3.0，6.0）22.0（19.0，26.0）
初中及以上260（24.88）4.0（2.0，6.0）22.0（19.0，26.0）
婚姻状态在婚825（78.95）4.0（3.0，6.0）-1.4990.13422.0（18.0，26.0）-0.8930.372
非在婚220（21.05）4.5（3.0，7.0）22.0（19.0，26.0）
), ArticleFig(id=1240746304909931133, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=EN, label=Table 3, caption=

Correlation analysis results of chronic pain degree, depression, frailty and cognitive function among the elderly in Nanshan Pastoral area

, figureFileSmall=null, figureFileBig=null, tableContent=
变量慢性疼痛程度抑郁衰弱躯体衰弱心理衰弱社会衰弱认知功能
慢性疼痛程度1.000
抑郁0.472a1.000
衰弱0.512a0.683a1.000
躯体衰弱0.451a0.491a0.825a1.000
心理衰弱0.453a0.621a0.877a0.627a1.000
社会衰弱0.431a0.649a0.833a0.469a0.672a1.000
认知功能-0.432a-0.469a-0.557a-0.480a-0.485a-0.441a1.000
), ArticleFig(id=1240746305027371659, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=CN, label=表3, caption=

南山牧区老年人慢性疼痛程度、抑郁、衰弱和认知功能状况相关性分析

, figureFileSmall=null, figureFileBig=null, tableContent=
变量慢性疼痛程度抑郁衰弱躯体衰弱心理衰弱社会衰弱认知功能
慢性疼痛程度1.000
抑郁0.472a1.000
衰弱0.512a0.683a1.000
躯体衰弱0.451a0.491a0.825a1.000
心理衰弱0.453a0.621a0.877a0.627a1.000
社会衰弱0.431a0.649a0.833a0.469a0.672a1.000
认知功能-0.432a-0.469a-0.557a-0.480a-0.485a-0.441a1.000
), ArticleFig(id=1240746305132229265, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=EN, label=Table 4, caption=

Tests the mediating model of depression and frailty

, figureFileSmall=null, figureFileBig=null, tableContent=
结果变量预测变量RR2F值OR值（95% CI）t值P值
抑郁慢性疼痛程度0.4360.19081.2250.595（0.516～0.674）14.814<0.001
年龄0.204（-0.064～0.471）1.4960.135
文化-0.332（-0.595～-0.069）-2.4800.013
衰弱慢性疼痛程度0.7650.585366.7460.318（0.271～0.366）13.079<0.001
抑郁0.446（0.412～0.479）26.104<0.001
年龄0.152（0.005～0.300）2.0280.043
文化-0.207（-0.352～-0.062）-2.7970.005
认知功能慢性疼痛程度0.5450.29787.902-0.350（-0.462～-0.238）-6.148<0.001
抑郁-0.225（-0.318～-0.131）-4.715<0.001
衰弱-0.457（-0.589～-0.325）-6.800<0.001
年龄0.080（-0.240～0.400）0.4910.623
文化0.057（-0.259～0.373）0.3550.723
), ArticleFig(id=1240746305220309657, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=CN, label=表4, caption=

抑郁和衰弱的中介模型检验

, figureFileSmall=null, figureFileBig=null, tableContent=
结果变量预测变量RR2F值OR值（95% CI）t值P值
抑郁慢性疼痛程度0.4360.19081.2250.595（0.516～0.674）14.814<0.001
年龄0.204（-0.064～0.471）1.4960.135
文化-0.332（-0.595～-0.069）-2.4800.013
衰弱慢性疼痛程度0.7650.585366.7460.318（0.271～0.366）13.079<0.001
抑郁0.446（0.412～0.479）26.104<0.001
年龄0.152（0.005～0.300）2.0280.043
文化-0.207（-0.352～-0.062）-2.7970.005
认知功能慢性疼痛程度0.5450.29787.902-0.350（-0.462～-0.238）-6.148<0.001
抑郁-0.225（-0.318～-0.131）-4.715<0.001
衰弱-0.457（-0.589～-0.325）-6.800<0.001
年龄0.080（-0.240～0.400）0.4910.623
文化0.057（-0.259～0.373）0.3550.723
), ArticleFig(id=1240746305388081829, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=EN, label=Table 5, caption=

Test of the chain mediating effect of depression and frailty on the degree of chronic pain and cognitive function in the elderly in Nanshan Pastoral area

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型OR值（95% CI）效应占比（%）
总效应-0.750（-0.852～-0.649）100.00
直接效应-0.350（-0.462～-0.238）46.67
总间接效应-0.400（-0.466～-0.336）53.33
Ind1慢性疼痛程度-抑郁-认知功能-0.134（-0.194～-0.074）17.87
Ind2慢性疼痛程度-衰弱-认知功能-0.145（-0.193～-0.101）19.33
Ind3慢性疼痛程度-抑郁-衰弱-认知功能-0.121（-0.165～-0.083）16.13
), ArticleFig(id=1240746305501328050, tenantId=1146029695717560320, journalId=1227665162245664772, articleId=1240375118111764903, language=CN, label=表5, caption=

抑郁和衰弱在南山牧区老年人慢性疼痛程度与认知功能之间的链式中介效应检验

, figureFileSmall=null, figureFileBig=null, tableContent=
效应类型OR值（95% CI）效应占比（%）
总效应-0.750（-0.852～-0.649）100.00
直接效应-0.350（-0.462～-0.238）46.67
总间接效应-0.400（-0.466～-0.336）53.33
Ind1慢性疼痛程度-抑郁-认知功能-0.134（-0.194～-0.074）17.87
Ind2慢性疼痛程度-衰弱-认知功能-0.145（-0.193～-0.101）19.33
Ind3慢性疼痛程度-抑郁-衰弱-认知功能-0.121（-0.165～-0.083）16.13
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新疆南山牧区老年人慢性疼痛程度与认知功能的关系：抑郁和衰弱的链式中介作用
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宋晓薇 1 , 袁媛 1 , 张宗云 1 , 孟娜 1 , 吴培 1 , 詹怀峰 2 , 陶宁 3 , 由淑萍 1
现代预防医学 | 流行病与统计方法 2024,51(6): 974-979
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现代预防医学 | 流行病与统计方法 2024, 51(6): 974-979
新疆南山牧区老年人慢性疼痛程度与认知功能的关系：抑郁和衰弱的链式中介作用
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宋晓薇1, 袁媛1, 张宗云1, 孟娜1, 吴培1, 詹怀峰2, 陶宁3, 由淑萍1
作者信息
  • 1.新疆医科大学护理学院，新疆 乌鲁木齐 830000
  • 2.新疆乌鲁木齐县板房沟中心卫生院
  • 3.新疆医科大学公共卫生学院

    • 宋晓薇（1991—），女，硕士在读，研究方向：社区护理学

通讯作者:

由淑萍，E-mail：
Relationship between chronic pain degree and cognitive function in the elderly in Nanshan Pastoral area of Xinjiang: the chain mediating role of depression and frailty
Xiao-wei SONG1, Yuan YUAN1, Zong-yun ZHANG1, Na MENG1, Pei WU1, Huai-feng ZHAN2, Ning TAO3, Shu-ping YOU1
Affiliations
  • School of Nursing, Xinjiang Medical University, Urumqi, Xinjiang 830000, China
出版时间: 2024-03-25 doi: 10.20043/j.cnki.MPM.202311331
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摘要
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目的

了解新疆南山牧区老年人慢性疼痛患病情况，探究慢性疼痛程度对认知功能的影响，以及抑郁和衰弱在其中的中介作用。

方法

于2022年6月至2023年2月采用多阶段随机整群抽样法抽取新疆南山牧区1 045例≥60岁的老年人作为研究对象。采用一般资料调查表、疼痛数字评定量表、老年抑郁评估量表、Tilburg衰弱量表、蒙特利尔认知评估量表进行问卷调查。

结果

新疆南山牧区老年人慢性疼痛患病率为67.27%（703/1 045）。慢性疼痛程度与抑郁、衰弱呈正相关（r=0.472、0.512, P<0.01），与认知功能呈负相关（r=-0.432, P<0.01）；抑郁和衰弱在慢性疼痛程度和认知功能之间中介效应显著，中介效应量分别为-0.134（95% CI:-0.194～-0.074）、-0.145（95% CI: -0.193～-0.101）；且抑郁-衰弱的链式中介效应也显著，中介效应量为-0.121（95% CI:-0.165～-0.083）。抑郁和衰弱在慢性疼痛程度与认知功能间的总间接效应值为-0.400，占总效应的53.33%。

结论

慢性疼痛程度不仅直接影响新疆南山牧区老年人的认知功能，还通过抑郁和衰弱的独立中介作用以及抑郁-衰弱的链式中介效应间接影响认知功能。

南山牧区  /  老年人  /  慢性疼痛  /  认知功能  /  链式中介
Objective

To investigate the prevalence of chronic pain in the elderly in Nanshan Pastoral area of Xinjiang, explore the influence of chronic pain degree on cognitive function, and the mediating role of depression and frailty.

Methods

From June 2022 to February 2023, 1 045 elderly patients ≥60 in Nanshan Pastoral area of Xinjiang were selected by multi-stage random cluster sampling method. The General Information Questionnaire, Pain Numerical Rating Scale, Geriatric Depression Assessment Scale, Tilburg Frailty Scale and Montreal Cognitive Assessment Scale were used to conduct the questionnaire survey.

Results

The prevalence rate of chronic pain in the elderly in Nanshan pastoral area of Xinjiang was 67.27% (703/1 045). The degree of chronic pain was positively correlated with depression and frailty (r=0.472, 0.512, P<0.01), and negatively correlated with cognitive function (r=-0.432, P<0.01). Depression and frailty had significant mediating effect between chronic pain degree and cognitive function. The intermediate effects were -0.134 (95% CI:-0.194--0.074) and -0.145 (95% CI: -0.193--0.101), respectively. The mediating effect of depression-debilitation chain was also significant, and the mediating effect size was -0.121 (95% CI:-0.165--0.083). The total indirect effect of depression and frailty on the degree of chronic pain and cognitive function was -0.400, accounting for 53.33% of the total effect.

Conclusion

The degree of chronic pain not only directly affects the cognitive function of the elderly in Nanshan pastoral area of Xinjiang, but also indirectly affects the cognitive function through the independent mediating effect of depression and frailty and the chain mediating effect of depression and frailty.

Nanshan Pastoral area  /  The elderly  /  Chronic pain  /  Cognitive function  /  Chain mediation
宋晓薇, 袁媛, 张宗云, 孟娜, 吴培, 詹怀峰, 陶宁, 由淑萍. 新疆南山牧区老年人慢性疼痛程度与认知功能的关系：抑郁和衰弱的链式中介作用. 现代预防医学, 2024 , 51 (6) : 974 -979 . DOI: 10.20043/j.cnki.MPM.202311331
Xiao-wei SONG, Yuan YUAN, Zong-yun ZHANG, Na MENG, Pei WU, Huai-feng ZHAN, Ning TAO, Shu-ping YOU. Relationship between chronic pain degree and cognitive function in the elderly in Nanshan Pastoral area of Xinjiang: the chain mediating role of depression and frailty[J]. Modern Preventive Medicine, 2024 , 51 (6) : 974 -979 . DOI: 10.20043/j.cnki.MPM.202311331
正文
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慢性疼痛严重影响老年人的身心健康和生活质量，给其家庭和社会带来沉重负担，已成为国内外研究者重点关注的公共卫生问题[1]。研究显示，受教育程度低、重体力劳动、患多种慢性疾病会增加老年人发生慢性疼痛的风险[1-2]。在新疆南山牧区，文化水平不高，同时患有高血压、骨关节病等疾病的老年人较多[3]。提示亟待关注新疆南山牧区老年人慢性疼痛患病情况，而目前相关研究较少。
研究表明，慢性疼痛可损害老年人的认知功能，使其出现记忆缺陷、注意力下降、执行功能受损等问题[4]。但目前慢性疼痛与认知功能之间的作用机制尚不明确。从既往研究[5-6]中可知，慢性疼痛和抑郁、衰弱关系紧密，疼痛程度越高，个体发生抑郁、衰弱的风险越高。抑郁在疼痛和衰弱之间充当中介[7]，衰弱和抑郁对老年人的认知功能具有负向影响[8-9]。
因此，本研究以新疆南山牧区老年人为研究对象，了解当地老年人慢性疼痛患病情况，聚焦慢性疼痛程度与认知功能的关系，探究抑郁、衰弱在慢性疼痛程度与认知功能间的作用，以期为延缓南山牧区老年人认知功能减退提供思路。
1 对象与方法
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1.1 研究对象
2022年6月至2023年2月，采用多阶段随机整群抽样法。第一阶段抽样：从新疆南山牧区（位于乌鲁木齐县）所在的乡镇中随机抽取1镇和1乡；第二阶段抽样：根据乡镇人口数在总人口数中所占比例，从镇中抽取7个村，乡中抽取3个村，对10个村中符合纳入排除标准的老年人进行问卷调查。纳入标准：（1）年龄≥60岁；（2）南山牧区居住时间≥1年；（3）自愿参加调查。排除标准：（1）内脏器官严重病变者；（2）恶性肿瘤者；（3）有癫痫、帕金森症等神经系统疾病史；（4）患焦虑、抑郁等精神疾病者。
样本量计算：；（其中P=35.71%[1]，Q=1-P，α=0.05，Zα=1.96，d为允许误差，一般取0.1P），样本量n=[384.16×(1-0.357 1)]/0.357 1=692例。由于整群抽样，增加50%的样本量，约1 038例。共发放1 060份问卷，回收1 045份，有效率98.58%。本研究得到参与者的知情同意与新疆医科大学伦理委员会批准(审批号：XJYKDXR20230908002)。
1.2 研究工具
1.2.1 一般资料调查表
调查表自行编制，包括性别、年龄、文化程度、婚姻状况、有无慢性疼痛。以存在持续或反复发作超过3个月的疼痛作为慢性疼痛的诊断标准[11]。
1.2.2 疼痛数字评定量表[12]（Numerical Rating Scale, NRS）
该量表用于评估老年人慢性疼痛程度，由0～10共11个数字组成，数字越大表示慢性疼痛程度越重。无慢性疼痛者NRS记为0。
1.2.3 中文版老年抑郁量表[13]（Geriatric Depression Scale, GDS）
该量表以老年人过去1周的感受评估其抑郁情况。共30个条目，除10个反向条目回答“否”计1分外，其余条目回答“是”计1分，得分为0～30分，≥11分为抑郁。该量表Cronbach α系数为0.846。
1.2.4 中文版Tilburg衰弱量表(Tilburg frailty indicator, TFI)[14]
该量表从躯体、心理、社会3 个维度评估老年人的衰弱状况，共15个条目，得分为0～15分，总分≥5分为衰弱，分数越高表示衰弱程度越严重。该量表Cronbach α系数为0.787[15]。
1.2.5 蒙特利尔认知评估量表（Montreal Cognitive Assessment, MoCA）[16]
该量表从视空间与执行能力、命名、注意力、计算、语言、抽象、延迟回忆、定向力8个方面评估老年人的认知功能，总分30分，≥26分表示认知功能正常，得分越高代表认知功能越好。该量表Cronbach α系数为0.807[17]。
1.3 资料收集和质量控制
成立研究小组，统一培训调查员，达到考核标准后实施研究。调查前对研究对象阐明研究目的等，获取其同意。调查中采用统一指导语，通过面对面询问获取资料。结束后核查信息，确保问卷的完整性和有效性。双人录入数据，再由一位有经验的研究员再次进行审核校对。
1.4 统计学处理
数据处理和分析采用SPSS 23.0。计数资料采用例数和百分比进行描述，非正态分布计量资料以M（P25，P75）表示。采用Mann-Whitney U秩和检验进行两组间比较，多组间比较采用Kruskal-Wallis H检验。采用Spearman秩相关分析，分析慢性疼痛程度、抑郁、衰弱、认知功能之间的关系。使用PROCESS 4.1宏程序和Bootstrap分析和检验抑郁、衰弱在慢性疼痛程度和认知功能之间的中介作用，若95% Bootstrap置信区间不包含0，则认为中介效应在P<0.05时是显著的。
2 结果
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2.1 研究对象基本情况
共调查1 045例老年人，平均年龄（70.58±6.94）岁。其中男性535例（51.20%），女性510例（48.80%）；文盲310例（29.67%），小学475例（45.45%），初中及以上260例（24.88%）；在婚状态825例（78.95%），非在婚220例（21.05%）；有慢性疼痛703例，无慢性疼痛342例，南山牧区老年人慢性疼痛患病率为67.27%。
2.2 不同特征下新疆南山牧区老年人慢性疼痛程度、抑郁、衰弱、认知功能得分比较
在不同的性别、婚姻状况下南山牧区老年人慢性疼痛程度、抑郁、衰弱、认知功能得分上的差异无统计学意义（P>0.05）；在不同的年龄段、文化水平下南山牧区老年人慢性疼痛程度、抑郁、衰弱、认知功能得分上的差异有统计学意义（P<0.05）。见表1，表2。
2.3 新疆南山牧区老年人慢性疼痛程度、抑郁、衰弱、认知功能之间的相关性分析
结果显示，南山牧区老年人慢性疼痛程度与抑郁（r=0.472, P<0.01）、衰弱（r=0.512，P<0.01）以及衰弱的三个维度（r=0.451、0.453、0.431，P<0.01）呈正相关，与认知功能（r=-0.432，P<0.01）呈负相关。见表3。
2.4 抑郁和衰弱在新疆南山牧区老年人慢性疼痛程度与认知功能之间的中介效应分析
以年龄和文化程度为控制变量，慢性疼痛程度为自变量，抑郁和衰弱为中介变量，认知功能为因变量纳入多重中介效应模型中，结果显示慢性疼痛程度显著正向预测抑郁（β=0.595，P<0.001）、衰弱（β=0.318，P<0.001），负向预测认知功能（β=-0.350，P<0.001）；抑郁正向预测衰弱（β=0.446，P<0.001），负向预测认知功能（β=-0.225，P<0.001）；衰弱显著负向预测认知功能（β=-0.457，P<0.001），详见表4。
2.5 抑郁和衰弱在南山牧区老年人慢性疼痛程度与认知功能之间的链式中介效应检验
Bootstrap法检验结果显示，在链式中介模型“慢性疼痛程度→抑郁→衰弱→认知功能”中，慢性疼痛程度对认知功能的总效应值为-0.750，总直接效应值为-0.350，总间接效应值为-0.400，其95% CI为（-0.466~-0.336），不包括0，说明中介效应显著，抑郁和衰弱在南山牧区老年人慢性疼痛程度和认知功能之间起部分中介作用，详见表5。
3 讨论
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新疆南山牧区老年人慢性疼痛患病率为67.27%，高于王瑞琪等[18]对全国28个省市老年人的调查结果（61.06%），可能是由于牧区老年人长期从事养殖牲畜、放牧等体力工作，自身较大的体重加重了关节负担，致使腰、膝等关节严重受损[2-3]，提示当地老年人慢性疼痛患病情况不容乐观，当地医疗卫生机构需重视老年人慢性疼痛的管理工作。相关分析结果显示，慢性疼痛程度与认知功能呈负相关，与Smith等[19]的研究结果一致。这可能是因为当个体经历高强度的疼痛时，参与决策、执行和情绪处理的内侧前额叶皮质需分配更多的资源来管理由疼痛产生的负面情绪，导致认知方面表现不佳[4]。提示可从降低慢性疼痛的强度着手，改善老年人的认知功能。
结果表明，抑郁在慢性疼痛程度与认知功能之间起部分中介作用。原因可能是慢性疼痛和抑郁的病理生理机制中涉及共同的脑区改变和化学物质，疼痛程度越严重，抑郁风险越大[20]，而抑郁促使β-淀粉样蛋白沉积，损害海马，致使认知功能受损[4]。因此，医疗卫生人员可通过有效疏通慢性疼痛患者的负性情绪，帮助降低认知功能受损的风险。此外，慢性疼痛程度可通过衰弱影响认知功能。随着疼痛程度加重，老年人的活动能力减弱，自主性降低，抵御应激的能力下降，衰弱的风险增加[21]。而衰弱是认知功能障碍的危险因素[22]。故除积极干预老年人的慢性疼痛外，还需关注其营养状况、活动能力等，引导其建立健康的生活行为方式，预防衰弱的发生，从而防止认知功能下降。
本研究发现，慢性疼痛程度可通过抑郁和衰弱的链式中介作用对认知功能产生影响。可能是因为较高的慢性疼痛强度降低了老年人日常锻炼和与人交往的意愿，引起身体、心理、社会多维度的衰弱，从而对认知功能产生不利影响[20-24]。提示当地卫生人员除降低老年人慢性疼痛强度外，还应疏解其不良情绪，指导其进行合理膳食和运动，从而有效降低慢性疼痛程度对认知功能的影响。
本研究创新性的探讨了新疆南山牧区老年人慢性疼痛程度、抑郁、衰弱、认知功能之间的关系及作用路径，为提升对当地老年人慢性疼痛的重视程度，制定改善其认知功能的干预措施提供了理论依据。但本研究是横断面研究，不能确定变量间的因果关系，未来可通过随机对照试验验证慢性疼痛程度和认知功能之间的联系。
基金
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  • 国家教育部人文社会科学研究项目(17YJCZH230)
  • 省部共建中亚高发病成因与防治国家重点实验室项目(SKL-HIDCA-2023-HL10)
  • 新疆医科大学大学生创新训练计划项目(X202310760075)
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2024年第51卷第6期
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doi: 10.20043/j.cnki.MPM.202311331
  • 接收时间：2023-11-16
  • 首发时间：2026-03-16
  • 出版时间：2024-03-25
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  • 收稿日期：2023-11-16
基金
国家教育部人文社会科学研究项目(17YJCZH230)
省部共建中亚高发病成因与防治国家重点实验室项目(SKL-HIDCA-2023-HL10)
新疆医科大学大学生创新训练计划项目(X202310760075)
作者信息
    1.新疆医科大学护理学院，新疆 乌鲁木齐 830000
    2.新疆乌鲁木齐县板房沟中心卫生院
    3.新疆医科大学公共卫生学院

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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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