摘要目的:考察慢性肾脏病（CKD）患者恐惧疾病进展、侵入性反刍、主动反刍与创伤后成长的关系，为临床护理开展身心并护、提高慢性肾脏病患者心理健康水平提供参考依据。方法:采用便利抽样法，于2019年9月—2020年2月在解放军总医院第三医学中心肾脏病科选取204例1～5期CKD患者，采用一般资料调查法、恐惧疾病进展简化量表、事件相关反刍性沉思问卷及创伤后成长量表对其进行调查。采用Pearson积差相关探析恐惧疾病进展、反刍思维、创伤后成长之间的相关性，采用PROCESS 3.0插件对数据进行中介效应分析，并用Boopstrap进行中介效应检验。结果:慢性肾脏病患者的恐惧疾病进展总分为（29.40±11.85）分，侵入性反刍总分为（21.17±8.37）分，主动性反刍总分为（23.54±8.44）分，创伤后成长总分为（51.68±27.18）分。相关分析结果显示，恐惧疾病进展、侵入性反刍、主动反刍与创伤后成长呈正相关（ P<0.01）；中介效应结果分析显示，恐惧疾病进展不能直接影响患者的创伤后成长，而通过侵入性反刍与主动反刍的链式中介效应对患者创伤后成长产生影响，侵入性反刍与主动反刍的链式中介效应有统计学意义，起到完全中介效应。 结论:恐惧疾病进展可通过侵入性反刍与主动反刍的链式中介作用间接影响创伤后成长，保持适度的恐惧疾病进展及反思性态度有利于产生创伤后成长。

abstractsObjective:To investigate relationships between fear of disease progression, invasive rumination, active rumination and post-traumatic growth in patients with chronic kidney disease (CKD) , so as to provide reference for carrying out physical and mental care in clinical nursing and improve the mental health level of patients with chronic kidney disease.Methods:From September 2019 to February 2020, 204 patients with stage 1 to 5 CKD were selected from Department of Nephrology in the Third Medical Center of PLA General Hospital by convenient sampling. They were investigated using a general data survey, the Short Form of the Fear of Progression Questionnaire (FoP-Q-SF) , Event Related Rumination Inventory (ERRI) and Posttraumatic Growth Inventory (PTGI) . Pearson product-moment correlation was used to analyze the correlations between fear of disease progression, ruminant thinking and post-traumatic growth. PROCESS 3.0 plug-in was used to analyze the mediating effect of the data, and Boopstrap was used to test the mediating effect.Results:The total scores of fears of disease progression, invasive rumination, active rumination and post-traumatic growth for CKD patients were respectively (29.40±11.85) , (21.17±8.37) , (23.54±8.44) and (51.68±27.18) . The results of correlation analysis showed that fear of disease progression, invasive rumination, and active rumination were positively correlated with post-traumatic growth ( P<0.01) . Analysis of mediating effect results showed that fear of disease progression could not directly affect post-traumatic growth of patients, but the chain mediating effect of invasive rumination and active rumination had an effect on post-traumatic growth of patients. And the chain mediating effect of invasive rumination and active rumination was statistically significant, which played a complete mediating effect. Conclusions:Fear of disease progression can indirectly affect post-traumatic growth through the chain mediating effect of invasive rumination and active rumination. Maintaining a moderate fear of disease progression and a reflective attitude is conducive to post-traumatic growth.