摘要
目的通过对西安市农村人群进行4年随访,构建认知功能下降的风险预测模型,并与经典衰老和痴呆发病率(CAIDE)预测模型比较。方法2014年10月—2015年3月在西安市鄠邑区2个自然村建立农村认知功能障碍队列,于基线和4年后应用简易精神状态量表(MMSE)评估认知功能,将MMSE分数下降≥4分定义为认知功能明显下降。将研究人群按照7∶3随机分为训练集和验证集,采用Logistic回归分析构建认知功能下降预测模型,采用受试者操作特征(ROC)曲线下面积(AUC)评价模型的区分度。结果最终纳入模型的变量包括年龄、文化程度和既往卒中史,训练集AUC为0.73(95%CI:0.63~0.79),验证集AUC为0.77(95%CI:0.67~0.87)。在研究人群中,CAIDE模型AUC为0.68(95%CI:0.61~0.75)。分层分析显示,APOEε4等位基因携带者中2种模型的预测效能均更好[本模型:AUC=0.87(95%CI:0.78~0.96),CAIDE模型:AUC=0.89(95%CI:0.81~0.98)]。结论结合年龄、文化程度和卒中史构建的预测模型,可以比较准确地预测4年后认知功能下降,优于经典的CAIDE模型,尤其在APOEε4等位基因携带者中,其预测价值更高,但是尚需进一步验证。
Objective To develop a risk predictive model of cognitive decline in a prospective cohort study in rural area of Xi’an and compare the predictive performance with that of the classical CAIDE model.Methods The cohort was established between October 2014 and March 2015 in two selected villages in rural Xi’an.Mini-Mental State Examination(MMSE)was applied to assess global cognition at baseline and 4-year follow-up,and cognitive decline was defined as a drop of≥4 points in MMSE after 4-year follow-up.Participants were randomly split into training set and validation set in a ratio of 7∶3.The Logistic regression analysis was used to develop the predictive model,and the area under the receiver operating characteristic(ROC)curve was applied to assess the performance of the risk model.Results Occurrence of cognitive decline after 4-year follow-up was 4.15%.Future cognitive decline was significantly predicted by age,low education and stroke(AUC in training set=0.73,95%CI:0.63-0.79;AUC in valid data=0.77,95%CI:0.67-0.87),while the classical CAIDE model did not predict the risk of cognitive decline well(AUC=0.68,95%CI:0.61-0.75).The results differed after stratification by APOE genotype,and showed a better predictive value of both our model(AUC=0.87,95%CI:0.78-0.96)and CAIDE model(AUC=0.89,95%CI:0.81-0.98)in APOEε4 carriers.Conclusion The predictive model was developed based on age,educational level and stroke,and it predicted relatively well 4-year cognitive decline as compared with traditional CAIDE model,especially in APOEε4 carriers.However,the model should be validated after longer follow-up and further improved to increase its predictive value.
作者
高玲
庞于成
商苏杭
党亮君
魏珊
王瑾
屈秋民
霍康
GAO Ling;PANG Yucheng;SHANG Suhang;DANG Liangjun;WEI Shan;WANG Jin;QU Qiumin;HUO Kang(Department of Neurology,The First Affiliated Hospital of Xi’an Jiaotong University,Xi’an 710061,China)
出处
《西安交通大学学报(医学版)》
北大核心
2025年第5期811-817,共7页
Journal of Xi’an Jiaotong University(Medical Sciences)
基金
国家科技部科技创新2030-“脑科学与类脑研究”重大项目(No.2021ZD0201808)
国家自然科学基金青年科学基金项目(No.82301364,No.82201580)
陕西省自然科学基础研究计划项目(No.2023-JC-YB-736)。
关键词
认知功能下降
预测模型
风险评估
队列研究
农村人群
cognitive decline
predictive model
risk assessment
cohort study
rural population
作者简介
通信作者:霍康,主治医师.E-mail:huokang@xjtufh.edu.cn;第一作者:高玲;共同第一作者:庞于成。
