社区老年高血压患者轻度认知功能障碍风险预测模型的构建与验证

doi:10.16460/j.issn1008-9969.2021.24.042

摘要/Abstract

摘要： 目的探讨社区老年高血压患者发生轻度认知功能障碍的风险因素,并构建风险预测模型。方法采用便利抽样,选取南宁市西乡塘区某社区老年高血压患者345例,按是否发生轻度认知功能障碍分为轻度认知功能障碍组（n=197）和非轻度认知功能障碍组（n=148）,比较2组患者一般资料、社会支持、服药依从性、睡眠障碍、是否存在焦虑症状、是否存在抑郁症状等情况。利用二分类Logistic回归建立风险预测模型,采用ROC曲线下面积检验及 Hosmer-Lemeshow检验检测模型鉴别效度和校准度,并选取南宁市青秀区某社区146例老年高血压患者进行模型预测效果验证。结果建模组中,最终纳入高血压分级（OR=2.699）、文化程度（中专/高中）（OR=0.075）、文化程度（大专/本科）（OR=0.044）、合并糖尿病（OR=4.321）、高血压年限（OR=3.539）、过去1年有应激史（OR=4.709）、吸烟（OR=2.703）、体育锻炼（经常）（OR=0.140）、阅读（偶尔）（OR=0.409）、阅读（经常）（OR=0.173）、社会支持总分（OR=0.939）、睡眠障碍（OR=2.283）、高服药依从性（OR=0.437）构建风险预测模型,模型内部验证结果显示其ROC曲线下面积为0.795,灵敏度为0.584,特异度为0.919,约登指数为0.503,阳性预测值为90.53%,阴性预测值为62.50%,Hosmer-lemeshow检验（P=0.703）。外部验证结果显示,ROC曲线下面积为0.765,灵敏度为0.63,特异度为0.877,约登指数为0.507,阳性预测值为84.46%,阴性预测值为65.52%,Hosmer-Lemeshow检验（P=0.234）。结论本研究建立的模型纳入了高血压分级,文化程度（中专/高中、大专/本科）,合并糖尿病,高血压年限,过去1年有应激史,吸烟,体育锻炼（经常）,阅读（偶尔、经常）,社会支持总分,睡眠障碍,高服药依从性,具有一定的预测效果,可有效预测社区老年高血压患者发生轻度认知功能障碍的风险。

关键词: 社区, 老年高血压, 轻度认知功能障碍, 风险预测模型

Abstract: Objective To explore the risk factors of mild cognitive impairment (MCI) in community-dwelling elderly patients with hypertension and to construct a risk prediction model. Methods A convenience sampling procedure was used to select 345 community-dwelling elderly patients with hypertension and they were divided into MCI group (n=197) and non-MCI group (n=148). The general information, social support, medication compliance, sleep disorder, with anxiety or not and with depression or not in the two groups were compared. A risk model was constructed by binary logistic regression and the area under the ROC curve and Hosmer-Lemeshow test were used to validate the prediction effect. Totally 146 community-dwelling elderly hypertensive patients from Qingxiu District of Nanning City participated in the validation of the prediction effect of the model. Results Factors including hypertension grading (OR=2.699), education background (technical secondary school or senior high school)(OR=0.075), education background (college or undergraduate)(OR=0.044),complicated with diabetes (OR=4.321), duration of hypertension (OR=3.539), history of stress in the past year (OR=4.709), smoking (OR=2.703), exercise (high frequency)(OR=0.140), occasional reading (OR=0.409), regular reading (OR=0.173), the total score of social support (OR=0.939), sleep disorder (OR=2.283), and good medication compliance (OR=0.437) were included into the construction of risk model. The area under the ROC curve was 0.795 with a sensitivity of 0.584, a specificity of 0.919, Youden index of 0.507, positive predictive value of 84.46% and negative predictive value of 65.52%. Hosmer-Lemeshow test (P=0.234). Conclusion The constructed model in the study includes factors of hypertension grading, education background (technical secondary school/senior high school, college/university), complicated with diabetes, duration of hypertension, history of stress in the past year, smoking, regular exercise, occasional or regular reading, the total score of social support, sleep disorder, and good medication compliance and the model has certain value in predicting the risk of MCI in community-dwelling elderly patients with hypertension.

Key words: community, senile hypertension, mild cognitive impairment, risk prediction model

中图分类号:

R473.2

陆静钰, 杨连招, 陈玲, 杨永. 社区老年高血压患者轻度认知功能障碍风险预测模型的构建与验证[J]. 护理学报, 2021, 28(24): 42-50.

LU Jing-yu, YANG Lian-zhao, CHEN Ling, YANG Yong. Construction and Validation of Risk Prediction Model of Mild Cognitive Impairment in Community-dwelling Elderly Hypertensive Patients[J]. Journal of Nursing, 2021, 28(24): 42-50.

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