摘要目的:探讨低血糖对2型糖尿病（T2DM）患者自我管理行为的影响及路径分析。方法:为横断面研究。采用便利抽样法，选择自2019年3至8月在天津医科大学朱宪彝纪念医院住院的1 180例T2DM患者作为研究对象。使用自行设计的一般资料调查表、中文版低血糖恐惧-忧虑量表（CHFSII-WS）、低血糖感知受损评估表-Gold法、糖尿病自我管理行为量表（SDSCA）进行问卷调查。采用路径分析方法探索低血糖与自我管理行为的关系。组间比较采用 t检验、单因素方差分析。采用多元线性回归分析法分析低血糖对T2DM患者自我管理行为的影响。运用AMOS 24.0软件进行路径分析，使用偏差校正的非参数百分位Bootstrap方法检验间接效应。 结果:患者SDSCA总分为（32.1±14.2）分。单因素分析结果显示，不同低血糖频次、低血糖类型、低血糖预防教育、低血糖恐惧感和低血糖感知状况的T2DM患者的SDSCA得分差异均有统计学意义（ P<0.001）。多元线性回归分析结果显示，假性低血糖、症状性低血糖、参加低血糖预防教育、低血糖恐惧感得分≥10分、没有发生过低血糖是T2DM患者自我管理行为的影响因素（ β=-0.216~0.218，均 P<0.05）。路径分析结果显示，低血糖预防教育、低血糖类型对T2DM患者自我管理行为产生直接效应和间接效应，总效应值分别为0.257、0.177；低血糖恐惧感有直接效应，效应值为0.155；低血糖感知状态有间接效应，效应值为0.03。 结论:低血糖预防教育、低血糖类型、低血糖恐惧感和低血糖感知状态对T2DM患者自我管理行为有正向作用。

abstractsObjective:To explore the effect of hypoglycemia on self-management behavior and its function route in patients with type 2 diabetes mellitus (T2DM).Methods:This study was a cross-sectional study. A total of 1 180 patients who were hospitalized in Tianjin Medical University Chu Hsien-I Memorial Hospital from March to August 2019, were investigated by convenient sampling. The subjects were surveyed by the questionnaires including the self-designed General Demographic Information Questionnaire, the Chinese version of Hypoglycemia Fear Survey Ⅱ-Worry Scale (CHFSII-WS), hypoglycemia perception impairment-Gold method, and the Summary of Diabetes Self Care Activities (SDSCA). The path analysis model was conducted to explore the relationship between hypoglycemia and self-management behavior in T2DM patients. The t test and one-way analysis of variance (ANOVA) were used for comparison between groups. Multiple linear regression analysis was used to analyze the impact of hypoglycemia on self-management with T2DM. The path analysis was conducted using AMOS 22.0 software. Nonparametric percentile Bootstrap method of bias correction was adopted to test indirect effects. Results:The total score of SDSCA was (32.1±14.2) points. Single factor analysis showed that the scores of self-management behavior in T2DM patients was significantly associated with the frequency of hypoglycemia, type of hypoglycemia, hypoglycemia prevention education, fear of hypoglycemia, hypoglycemia awareness state (all P<0.001). Multiple linear regression analysis showed that pseudo-hypoglycemia, documented symptomatic hypoglycemia, hypoglycemia prevention education and the scores of CHFSII-WS≥10 points, no experience of hypoglycemia were the influencing factors of self-management behavior ( β=-0.216-0.218, all P<0.05) in T2DM patients. Hypoglycemia prevention education, hypoglycemia types had direct and indirect effects on the self-management behavior of T2DM patients, with the total effect values of 0.257 and 0.177, respectively. The effect value of fear of hypoglycemia had a direct effect of 0.155, and the effect value of hypoglycemia awareness state had an indirect effect of 0.032. Conclusions:Hypoglycemia prevention education, hypoglycemia types, fear of hypoglycemia and hypoglycemia awareness state have a positive effect on the self-management behavior of T2DM patients.