目的 分析健康素养和久坐行为在老年维持性血液透析（maintenance hemodialysis，MHD）患者孤独感对衰弱的链式中介作用。方法 2022年1月至2023年12月，采用便利抽样法选取江苏省人民医院收治的216例老年MHD患者为研究对象，采用Tilburg衰弱量表（tilburg frailty index，TFI）、孤独感量表（University of California at Los Angeles loneliness scale,UCLA-LS）、慢性病患者健康素养量表（health literacy management scale，HeLMS）、老年人久坐行为问卷对其进行调查。结果 老年MHD患者，久坐行为时间为（7.24±0.67）h/d。衰弱与孤独感、久坐行为之间呈正相关，与健康素养之间呈负相关（均P＜0.05）。健康素养、久坐行为以及健康素养-久坐行为在孤独感与衰弱之间发挥部分中介效应，效应值分别为0.21、0.20、0.08，占总效应的20.39%、19.42%、7.76%。结论 孤独感可以通过调节健康素养和久坐行为，间接影响老年MHD患者衰弱程度。

Objective To analyze the chain mediating effect of health literacy and sedentary behavior on the relationship between loneliness and frailty in elderly patients undergoing maintenance hemodialysis (MHD).Methods From January 2022 to December 2023,a convenience sampling method was used to select 216 elderly MHD patients admitted to Jiangsu Province Hospital.They were assessed using the Tilburg Frailty Index (TFI),the University of California,Los Angeles Loneliness Scale (UCLA-LS),the Health Literacy Management Scale (HeLMS),and the Elderly Sedentary Behavior Questionnaire.Results The average sedentary behavior time among elderly MHD patients was (7.24±0.67) hours/day.Frailty was positively correlated with loneliness and sedentary behavior,and negatively correlated with health literacy (P＜0.05).Health literacy,sedentary behavior,and the health literacy-sedentary behavior chain played partial mediating roles in the relationship between loneliness and frailty,with effect sizes of 0.21,0.20,and 0.08,accounting for 20.39%,19.42%,and 7.76% of the total effect,respectively.Conclusions Loneliness can indirectly influence the degree of frailty in elderly MHD patients by modulating health literacy and sedentary behavior.

R47

江苏省卫生健康委医学科研立项项目（M2022186）