偏颇质得分对健康相关生命质量的影响：运动的中介作用
摘要： 背景 偏颇质、运动和健康相关生命质量（HRQOL）三者之间两两关系的研究较多，但关于三者之间关系的研究较少。 目的 探讨运动在8种偏颇质与HRQOL间的作用机制。 方法 采用方便抽样法选取2015年7—11月、2016年5—9月于北京市红十字血液中心献血小屋和采血车上的无偿献血者和陪同的非献血者为研究对象进行问卷调查。运动水平由自我报告获得；偏颇质采用中医体质量表（CCMQ）得分评价；HRQOL采用简明健康状况调查问卷（SF-36）得分评价，得分越高代表生命质量越好。采用Pearson相关分析探究HRQOL、运动水平和8种偏颇质之间的相关性，进一步采用多元线性回归模型探讨运动在偏颇质与HRQOL之间的中介作用。 结果 本研究共发放问卷1 828份，回收1 771份，剔除不合格问卷（填写不完整、存在逻辑错误）29份，有效问卷1 742份，有效回收率为95.30%。1 742例受试者SF-36得分为（84.42±12.05）分，CCMQ中8种偏颇质亚量表得分分别为：气虚质（23.20±14.61）分，阳虚质（20.03±18.12）分，阴虚质（20.87±15.20）分，痰湿质（19.78±14.65）分，湿热质（21.70±16.57）分，血瘀质（17.68±14.08）分，气郁质（19.63±15.63）分，特禀质（15.30±13.62）分。Pearson相关分析结果显示，8种偏颇质得分与HRQOL（SF-36得分）均呈负相关（r为-0.413~-0.612，P<0.01）；除特禀质外，其余7种偏颇质得分与运动水平呈负相关（r为-0.072~-0.176，P<0.01）；运动水平与HRQOL（SF-36得分）呈正相关（r=0.145，P<0.01）。中介效应检验结果显示，运动在除特禀质外的其余7种偏颇质与HRQOL间的中介作用具有统计学意义（P<0.05），中介作用效果量从大到小依次是痰湿质（2.13%）、阳虚质（2.05%）、湿热质（1.88%）、阴虚质（1.55%）、血瘀质（1.48%）、气郁质（1.37%）、气虚质（1.16%）。 结论 中医体质的8种偏颇质（痰湿质、阳虚质、湿热质、阴虚质、血瘀质、气郁质、气虚质、特禀质）与HRQOL呈负相关，运动在除特禀质外的7种偏颇质与HRQOL中起不同程度的部分中介作用，但中介作用效果量均较小。
关键词: 中医体质, 偏颇质, 健康相关生命质量, 运动, 中介作用
Abstract:
Background
The pairwise correlation among biased constitution, exercise and health-related quality of life (HRQOL) has been extensively studied, while the relationship among the three has been rarely explored.
Objective
To explore the mediating effect of exercise on the relationship of 8 kinds of biased constitution with HRQOL.
Methods
By use of convenience sampling, unpaid blood donors and their companions were selected as participants from blood donation cabins and blood collecting vehicles of Beijing Red Cross Blood Center from July to November 2015 and May to September 2016 . The exercise level was obtained by the self-report method. The biased constitution was assessed using the Constitution in Chinese Medicine Questionaire (CCMQ) . The HRQOL was evaluated by the Chinese version of the 36-Item Short Form Health Survey (SF-36) , and a higher score indicates a higher quality of life. Pearson correlation analysis was used to explore the correlation among HRQOL (score of SF-36) , exercise level and 8 kinds of biased constitution. Multiple linear regression model was applied to explore the mediating effect of exercise on the relationship between HRQOL and biased constitution.
Results
A total of 1 828 cases attended the survey, 1 771 of them returned questionnaires, and after excluding 29 who inappropriately (incompletely or illogically) answered questionnaires, the remaining 1 742 cases (95.30%) were included for analysis. The mean SF-36 score of 1 742 subjects was (84.42±12.05) points. And the mean scores of the 8 biased constitution subscales of CCMQ for them were: qi-deficiency: (23.20±14.61) points, yang-deficiency: (20.03±18.12) points, yin-deficiency: (20.87±15.20) points, phlegm-dampness: (19.78±14.65) points, dampness-heat: (21.70±16.57) points, blood-stasis: (17.68±14.08) points, qi-depression: (19.63±15.63) points, specific-diathesis: (15.30±13.62) points. The score of each of the 8 kinds of biased constitution was negatively correlated with HRQOL (r: -0.413 - -0.612, P<0.01) . Except for specific-diathesis type, biased constitution scores were negatively correlated with exercise level (r: -0.072 - -0.176, P<0.01) . Exercise level was positively correlated with HRQOL (r=0.145, P<0.01) . Mediation analysis revealed that, exercise played a significant mediating effect on the relationship between HRQOL and biased constitution except the specific-diathesis type (P<0.05) . And the size of mediating effect in a descending order was 2.13% between HRQOL and phlegm-dampness, 2.05% between HRQOL and yang-deficiency, 1.88% between HRQOL and dampness-heat, 1.55% between HRQOL and yin-deficiency, 1.48% between HRQOL and blood-stasis, 1.37% between HRQOL and qi-depression, 1.16% between HRQOL and qi-deficiency.
Conclusion
Eight kinds of biased constitution (phlegm-dampness, yang-deficiency, dampness-heat, yin-deficiency, blood-stasis, qi-depression, qi-deficiency, and specific-diathesis) negatively affected the HRQOL. Although exercise partially played a role in mediating the relationship of HRQOL with the other 7 types of biased constitution except specific-diathesis, the effect size was generally little.
Key words: Traditional Chinese medicine constitution, Biased constitution, Health-related quality of life, Sports, Mediating effect
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