104例ACI患者继发血管...影响因素回归模型构建及分析_王文婷.pdf

J Med Theor PracVol.36，No.3，Feb20232023年第36卷第3期医学理论与实践104 例 ACI 患者继发血管性认知障碍影响因素回归模型构建及分析王文婷甘肃省天水市第一人民医院741000摘要目的:分析 104 例急性脑梗死(ACI)患者继发血管性认知障碍影响因素并构建回归模型。方法:回顾性收集2020 年 1 月2022 年 4 月我院收治的 104 例 ACI 患者临床资料，根据患者是否继发血管性认知障碍将其分为认知障碍组(n=45)和非认知障碍组(n=59)，统计 ACI 继发血管性认知障碍的单因素，采用多因素 Logistic 回归分析 ACI 继发血管性认知障碍的影响因素，并据其构建 ACI 继发血管性认知障碍的预测模型，采用 MedCalc11 4 绘制受试者工作特征曲线(OC)分析预测模型对 ACI 继发血管性认知障碍的预测价值，获取曲线下面积(AUC)。结果:多因素 Logis-tic 回归分析结果显示，年龄较大、合并颈动脉粥样硬化、合并高血压、合并糖尿病、脑白质疏松、梗死部位为额叶/颞叶/丘脑、卒中后抑郁、血清 Hcy 水平较高均为 ACI 患者继发血管性认知障碍的独立危险因素(O=3 827、2 713、3.501、3 271、3 010、2 192、4 764、2 672，P 0 05)，受教育年限较长为 ACI 患者继发血管性认知障碍的保护因素(O=0 349，P 0 05)。根据多因素 Logistic 回归分析结果建立预测模型为 logit(P)=11 026+年龄 1 342+合并颈动脉粥样硬化 0 998+合并高血压 1 253+合并糖尿病 1 185+脑白质疏松 0 975+梗死部位为额叶/颞叶/丘脑 0 785+卒中后抑郁 1 561 受教育年限 1 053+血清 Hcy 水平 0 983，OC 曲线显示，当 logit(P)12.11 时，回归模型预测 ACI 患者继发血管性认知障碍发生的 AUC 值为0 913，敏感度为91 11%，特异度为77.97%。结论:ACI 患者继发血管性认知障碍的独立危险因素包括年龄较大、合并颈动脉粥样硬化、合并高血压、合并糖尿病、脑白质疏松、梗死部位为额叶/颞叶/丘脑、卒中后抑郁、血清 Hcy 水平较高，保护因素为受教育年限较长，同时相关回归模型对 ACI 患者继发血管性认知障碍的预测价值较好，临床可据此对 ACI 患者继发血管性认知障碍进行预测，降低 ACI 患者继发血管性认知障碍的风险。关键词急性脑梗死血管性认知障碍影响因素回归模型受试者工作特征曲线中图分类号:743文献标识码:Adoi:10.19381/j.issn.1001-7585.2023.03.004Construction and Analysis of egression Model for Influencing Factors of Secondary Vascular Cognitive Impairmentin 104 Patients with ACIWANG Wenting The First People s Hospital of Tianshui City，Gansu Province741000ABSTACT Objective:To analyze the influencing factors of secondary vascular cognitive impairment in 104 patients with a-cute cerebral infarction(ACI)and to construct a regression model Methods:The clinical data of 104 patients with ACI ad-mitted to our hospital from January 2020 to April 2022 were retrospectively collected According to whether the patients hadsecondary vascular cognitive impairment，they were divided into cognitive impairment group(n=45)and non-cognitive im-pairment group(n=59)The single factors of vascular cognitive impairment secondary to ACI were analyzed Multivariate Lo-gistic regression was used to analyze the influencing factors of vascular cognitive impairment secondary to ACI，and the predic-tion model of vascular cognitive impairment secondary to ACI was constructed according to it The receiver operating character-istic curve(OC)of MedCalc11 4 was used to analyze the predictive value of the prediction model for vascular cognitive im-pairment secondary to ACI，obtain the area under the curve(AUC)esults:Multivariate Logistic regression analysis showedthat older age，carotid atherosclerosis，hypertension，diabetes mellitus，leukoaraiosis，frontal/temporal/thalamus Location ofinfarction，post-stroke depression，and high the level of serum Hcy are independent risk factors for secondary vascular cogni-tive impairment in patients with ACI(O=3 827，2 713，3 501，3 271，3 010，2 192，4 764，2 672，P 0 05)，longeryears of education was the protective factor of vascular cognitive impairment secondary to ACI(O=0 349，P 0 05)Ac-cording to the results of multivariate Logistic regression analysis，the prediction model was established as logit(P)=11.026+age 1 342+carotid atherosclerosis 0 998+hypertension 1 253+diabetes 1 185+leukuarosis 0.975+fron-tal lobe/temporal lobe/thalamus 0 785+post-stroke depression 1 561 years of education 1 053+the level of serumHcy 0 983，OC curve showed that when logit(P)12 11，the AUC value of the regression model to predict the occurrenceof secondary vascular cognitive impairment in ACI patients was 0 913，and the sensitivity was 91 11%，the specificity was273医学理论与实践2023年第36卷第3期Vol.36，No.3，Feb2023J Med Theor Prac77.97%Conclusion:Patients with ACI were independent risk factors for the development of secondary vascular cognitive im-pairment including older age，carotid atherosclerosis，hypertension，diabetes mellitus，leukoaraiosis，frontal/temporal/thala-mus location of infarction，post-stroke depression，and high the level of serum Hcy，longer years of education was the protec-tive factor of vascular cognitive impairment secondary to ACI At the same time，the correlation regression model had a goodpredictive value for the secondary vascular cognitive impairment in patients with ACI，which could be used to predict the sec-ondary vascular cognitive impairment in patients with ACI and reduce the risk of secondary vascular cognitive impairment inpatients with ACIKEY WODSAcute cerebral infarctionVascular cognitive impairmentInfluencing factorsegression modele-ceiver operating characteristic curve急性脑梗死(ACI)是脑卒中主要类型，其发病率占脑卒中发病率的 60%80%，可对患者神经系统造成严重损害，临床致残率较高。血管性认知障碍是 ACI 患者主要继发性疾病，其可严重影响患者生活能力和社会交往能力，不利于患者后期康复1-2。相关统计研究3 结果显示，脑卒中是导致血管性认知障碍发生的主要危险因素之一，但目前关于 ACI 患者继发血管性认知障碍的相关影响因素尚未完全明确，基于此，本研究通过分析 ACI 患者继发血管性认知障碍的相关影响因素，并构建回归模型，为临床预防 ACI 患者继发血管性认知障碍提供参考和依据，现将结果报道如下。1资料与方法1 1一般资料回顾性收集 2020 年 1 月2022年 4 月我院收治的 104 例 ACI 患者临床资料，根据患者是否继发血管性认知障碍将其分为认知障碍组(n=45)和非认知障碍组(n=59)。本研究获本院医学伦理委员会审核批准。1 2纳入、排除及剔除标准纳入标准:ACI 诊断符合 中国急性缺血性急性缺血性脑梗死诊治指南20144 中的相关标准者;血管性认知障碍诊断符合神经内科学5 中的相关标准者;无脑血管手术史者;无其他脑血管疾病史者;无脑部手术史或创伤史者等。排除标准:精神疾病病史者;先天性脑发育不全者;合并恶性肿瘤者等。剔除标准:临床资料不完整者。1 3方法与观察指标1 3 1ACI 继发血