摘要目的:探讨侵袭性思维与心理困扰在肾移植受者疾病进展恐惧感和生命质量间的链式中介效应，以期为临床针对肾移植受者实施有效的心理干预提供科学的理论指导。方法:本研究为横断面研究，采用便利抽样法，选择2019年1—5月在中国科学技术大学附属第一医院门诊随访的312例肾移植受者，采用一般资料调查表、疾病进展恐惧简化量表、事件影响量表的侵扰分量表、心理痛苦温度计以及简短生命质量量表对其进行调查。运用Mplus 8.3软件构建多重中介模型并进行验证。结果:本研究最终纳入296例肾移植受者，生命质量心理健康得分为（49.58±8.97）分，躯体健康得分为（49.90±9.17）分。疾病进展恐惧感、侵袭性思维、心理困扰与生命质量的心理健康和躯体健康均呈负相关（ r值为-0.453～-0.401， P<0.01）。疾病进展恐惧感对生命质量的中介效应成立，总的中介效应值为-0.273，其中侵袭性思维的特定中介效应占46.52%，心理困扰的特定中介效应占41.76%，侵袭性思维与心理困扰在疾病进展恐惧感和生命质量间的链式中介效应占11.72%。 结论:肾移植受者的侵袭性思维与心理困扰在疾病进展恐惧感和生命质量间的链式中介成立。临床工作人员在关注患者疾病恐惧感的同时，应注重评估患者的侵袭性思维和心理困扰，采取针对性的措施以减轻疾病进展恐惧感对生命质量的影响。

abstractsObjective:To explore the chain mediating effect of intrusive thinking and psychological distress on the fear of disease progression and quality of life of kidney transplant recipients, with a view to providing scientific theoretical guidance for effective psychological interventions for kidney transplant recipients.Methods:This study is a cross-sectional study. Convenience sampling was used to select 312 kidney transplant recipients who were followed up in the Outpatient Clinic of the First Affiliated Hospital of University of Science and Technology of China from January to May 2019. Patients were investigated with the General Information Questionnaire, the Fear of Progression Questionnaire, the Impact of Events Scale-Revised Intrusion Subscale, Distress Thermometer and 12-Item Short-Form Health Survey Questionnaire. Mplus 8.3 was used to construct and verify multiple intermediary models.Results:A total of 296 kidney transplant recipients were included in this study. In quality of life, the mental health score was (49.58±8.97) , and the physical health score was (49.90±9.17) . Fear of disease progression, intrusive thinking and psychological distress were all negatively correlated with mental health and physical health of quality of life (the r values were -0.453 to -0.401, P<0.01) . The mediating effect of fear of disease progression on the quality of life was established. The total mediating effect value was -0.273, and the specific mediating effect of intrusive thinking accounted for 46.52%, and the specific mediating effect of psychological distress accounted for 41.76%. The chain mediating effect of intrusive thinking and psychological distress between fear of disease progression and quality of life accounted for 11.72%. Conclusions:The intrusive thinking and psychological distress of kidney transplant recipients are established as a chain mediation between the fear of disease progression and the quality of life. While paying attention to patients' fear of disease, clinical staff should pay attention to assessing patients' intrusive thinking and psychological distress, and take targeted measures to reduce the impact of fear of disease progression on the quality of life.