摘要
目的分析脑创伤后认知功能障碍发生的独立危险因素,构建脑创伤后认知功能障碍危险因素的预测模型,并验证风险预测模型的有效性,为早期预测脑创伤后认知功能障碍的发生风险提供临床工具。方法第一部分,回顾性收集2021年2—5月于河北省唐山、沧州、承德21所三级、二级医院住院治疗的脑创伤患者(训练集556人),进行蒙特利尔认知评估,并收集通过文献研究获取的33个影响因素(一般资料、症状体征、实验室及影像学指标),依据认知障碍与否将患者分为病例组和对照组,单因素、多因素分析筛选独立危险因素。第二部分,运用二分类逻辑回归方程构建认知障碍预测模型,列线图可视化呈现模型。第三部分,收集2021年8—10月前述21所医院住院治疗的脑创伤患者(验证集260人)作为认知障碍预测模型的前瞻性验证人群,病例组对照组分类同前,比较两组危险因素。绘制代表模型区分度的受试者工作特征(receiver operating characteristic curve,ROC)曲线、校准曲线图和模型临床适用度评价模型效能等进行模型内外部验证。结果二分类Logistic回归分析显示,脑创伤后认知功能障碍危险因素为基底节损伤、损伤程度为重度、受伤后失忆经历、受伤后经常头痛、受伤后上肢功能障碍、年龄≥60岁、文化程度为小学及以下。可视化列线图模型显示症状因素中受伤后失忆经历、受伤后经常头痛、上肢功能障碍、损伤程度是本模型中影响创伤性脑损伤认知障碍发生风险的贡献较大的因素。预测模型区分度使用ROC曲线下面积的值(area under curve,AUC)显示内部验证和外部验证,分别为R语言分析的0.868和0.885,SPSS分析的0.868和0.901;模型校准度校准后曲线几乎与参考线相重合,Hosmer-Lemeshow检验P>0.05;模型临床适用度绘制的两条决策曲线(decision curve analysis,DCA)高于两条极端曲线,预测TBI认知障碍患者能从预测模型中获益,在Pt为0.1~0.8范围内,在Pt达到约0.1时直至近似1.0复合评价模型均存在净受益率。结论受伤后失忆经历、受伤后经常头痛、上肢功能障碍、损伤程度等危险因素是创伤性脑损伤认知障碍发生风险贡献较大的预测因子,其预测模型的预测作用良好、预测准确性较高、临床适用度较好,可应用于临床诊断。
Objective To analyze the independent risk factors for the occurrence of post-traumatic cognitive dysfunction,construct a prediction model for the risk factors of post-traumatic cognitive dysfunction,and verify the effectiveness of the risk prediction model,so as to provide a clinical tool for early prediction of the risk of post-traumatic cognitive impairment.Methods Part I:patients with brain trauma(training set with 556 subjects)who were hospitalized in 21 tertiary and secondary hospitals from Tangshan,Cangzhou and Chengde cities of Hebei province were retrospectively collected from February to May 2021 for Montreal cognitive assessment,and 33 influencing factors(general data,symptoms and signs,laboratory and imaging parameters)were obtained obtained through literature research.The patients were divided into case group and control group according to whether they had cognitive impairment or not,and univariate and multivariate analysis were used to screen independent risk factors.PartⅡ:a binary Logistic regression equation was used to construct a cognitive impairment prediction model,the visualization model of line graph is presented.PartⅢ:brain trauma patients(260 subjects of the validation set)hospitalized in the aforementioned 21 hospitals from August to October 2021 were collected as a prospective validation population for the prediction model of cognitive impairment,and the grouping basis of case group and control group was the same as before.And the risk factors between the two groups were compared.The receiver operating characteristic curve(ROC),calibration curve and clinical applicability of the model were drawn to evaluate the effectiveness of the model for internal and external verification of the model.Results Binary Logistic regression analysis showed that the risk factors for post-traumatic cognitive dysfunction were basal ganglia injury,severe injury,amnesia experience after injury,frequent headache after injury,upper limb dysfunction after injury,age≥60 years,and education level of elementary school or below.Visual nomograms showed that the experience of amnesia after injury,frequent headache after injury,upper limb dysfunction,and degree of injury among the symptom factors were the factors that contributed greatly to the risk of traumatic brain injury cognitive impairment in this model.Predictive model discrimination using area under curve(AUC)values of the area under the ROC curve showed that internal validation and external validation were 0.868 and 0.885 for R language analysis and 0.868 and 0.901 for SPSS analysis,respectively.The curve after model calibration almost coincided with the reference line,Hosmer-Lemeshow test P>0.05.The two decision curve analysis(DCA)curves drawn by the clinical applicability of the model were higher than the two extreme curves,predicting that traumatic brain injury patients with cognitive impairment could benefit from the predictive model,and there was a net benefit rate in the range of Pt about 0.1-0.8,when Pt reached about 0.1 until the approximate 1.0 composite evaluation model.Conclusion Risk factors such as experience of amnesia after injury,frequent headache after injury,upper limb dysfunction,and degree of injury are predicting factors contributed to the risk of cognitive impairment in traumatic brain injury,and their prediction models have good predictive effect,high predictive accuracy and good clinical applicability,which can be applied in clinical diagnosis.
作者
郝习君
雷平
马潇斌
陈长香
Hao Xijun;Lei Ping;Ma Xiaobin;Chen Changxiang(Department of Geriatrics,Tianjin Medical University General Hospital,Tianjin 300052,China;Department of Nursing and Rehabilitation Medicine,North China University of Science and Technology,Tangshan 063210,China)
出处
《中华行为医学与脑科学杂志》
CAS
CSCD
北大核心
2023年第1期37-44,共8页
Chinese Journal of Behavioral Medicine and Brain Science
基金
河北省科技厅重点研发计划项目(22377758D)。
关键词
脑创伤
认知功能障碍
危险因素
预测模型
Brain trauma
Cognitive impairment
Risk factors
Prediction model
作者简介
通信作者:雷平,Email:Leiping1974@163.com。
