贝叶斯半参数多状态模型在老年人认知与抑郁关系研究中的应用  

Bayesian Semiparametric Multi-state Models in Relation between Cognition and Depression among the Elderly

作　　者：段耀飞 宋泽婧 薛海红 樊莹 余红梅[1] Duan Yaofei;Song Zejing;Xue Haihong;et al(Department of Health Statistics, Shanxi Medical University （030001）, Taiyuan)

机构地区：[1]山西医科大学卫生统计教研室,030001

出　　处：《中国卫生统计》2018年第2期189-193,共5页Chinese Journal of Health Statistics

基　　金：国家自然科学基金资助项目(81673277;81373106)

摘　　要：目的探讨影响老年人认知功能与抑郁的因素以及认知功能与抑郁的关系。方法利用太原市社区老年人2010年10月至2014年5月的8次随访资料,对287名研究对象构建仅轻度认知损害(mild cognitive impairment,MCI)、仅抑郁症、仅阿尔茨海默病(Alzheimer’s disease,AD)、MCI与抑郁症共病、AD与抑郁症共病的五状态贝叶斯半参数多状态模型。结果贝叶斯半参数多状态模型拟合良好。仅MCI到MCI与抑郁症共病有统计学意义的变量为铝制炊具、体育活动、做家务情况与心脏病;仅MCI到仅AD有统计学意义的变量为年龄与公益活动;仅抑郁症到MCI与抑郁症共病有统计学意义的变量为控制饮食;仅AD到AD与抑郁症共病有统计学意义的变量为年龄、控制饮食、体育活动与业余爱好;MCI与抑郁症共病到AD与抑郁症共病有统计学意义的变量为教育水平、体育活动与脑部疾病。认知功能得分在仅MCI到MCI与抑郁症共病的风险比(hazard ratio,HR)为1.017(95%CI:0.920~1.124);在仅AD到AD与抑郁症共病的HR为0.769(95%CI:0.671~0.882)。抑郁得分在仅抑郁症到MCI与抑郁症共病的HR为0.885(95%CI:0.761~1.030)。结论认知损害较严重时可能会导致抑郁症发生,抑郁症可能不会导致发生认知损害。贝叶斯半参数多状态模型与传统的生存分析方法相比,在慢性病共病影响因素研究中更具优势。Objective To explore the influencing factors and relation regarding cognition and depression in the elderly. Methods The data came from eight waves of cohort study of 287 community-dwelling elders in Taiyuan from October 2010 to May 2014. Bayesian semiparametric multi-state models was constructed, which was based on five states：only mild cognitive im- pairment （MCI）, only depression, only Alzheimer＇ s disease （AD）, MCI and depression co-existing, AD and depression co-ex- isting. Results Bayesian semiparametric multi-state models fitted the data well. Multivariate analysis showed that aluminum cooking utensils, sports activities, doing housework and heart disease were statistically significant for transition from only MCI to MCI and depression co-existing ; age and socially useful activities were statistically significant for transition from only MCI to only AD;dietary restriction was statistically significant for transition from only depression to MCI and depression co-existing;age, dietary restriction, sports activities and hobbies were statistically significant for transition from only AD to AD and depression coexisting;educational level, sports activities and cerebral disease were statistically significant for transition from MCI and depres- sion co-existing to AD and depression co-existing. Hazard ratio （HR） of cognition scores was 1. 017 （95% CI：0. 920 - 1. 124） for transition from only MCI to MCI and depression co-existing and 0. 769 （95% CI：O. 671 - 0. 882） for transition from only AD to AD and depression co-existing. For transition from only depression to MCI and depression co-existing, HR of depression scores was 0. 885 （95% CI：0. 761 - 1. 030）. Conclusion Severe cognitive impairment may lead to depression,while depression may not lead to cognitive impairment. Bayesian semiparametric multi-state models have more advantages over other traditional methods in exploring influencing factors of chronic diseases co-existing studies.

关 键 词：贝叶斯半参数多状态模型 阿尔茨海默病 认知功能 抑郁 

分 类 号：R749.16[医药卫生—神经病学与精神病学]