急性部分前循环梗死老年患者血管性认知功能障碍的诊断预测模型  

A diagnostic and predictive model for vascular cognitive impairment in elderly patients with acute partial anterior circulation infarction

作　　者：蒙莲 覃莲[1] 莫振华 廖宝共[1] 覃君德[1] 韦彬[1] 卢非[1] 陈洪乔 雷江 黄进瑜[1] Meng Lian;Qin Lian;Mo Zhenhua;Liao BaogongQin J undeWei Bin;Lu Fei;Chen Hongqiao;Lei Jiang;Huang Jinyu(Department of Neurology,the First Affiliated Hospital of Guangri University of Science and Technology,Liuzhou 545002,China)

机构地区：[1]广西科技大学第一附属医院神经内科,柳州545002

出　　处：《中华老年医学杂志》2020年第9期1011-1015,共5页Chinese Journal of Geriatrics

基　　金：广西医疗卫生适宜技术研究与开发项目(S201317-01)。

摘　　要：目的探讨急性部分前循环梗死(PACI)患者发病后12~18个月出现血管性认知功能障碍(VCI)的相关因素,并建立诊断预测模型。方法前瞻性分析,收集148例PACI患者的发病急性期的人口学资料、血管性危险因素和实验室指标,并随访12~18个月,应用蒙特利尔认知评估量表(MoCA)评价患者认知功能,用Logistic逐步回归筛选与VCI相关的危险因素,建立诊断预测模型,使用受试者工作特征曲线(ROC)评价模型预测能力。结果共有126例患者完成随访,多因素Logistic回归分析结果显示,高同型半胱氨酸(OR=1.082,95%CI:1.002~1.167)、高糖化血红蛋白(OR=1.653,95%CI:1.052~2.598)、高美国国立卫生研究院脑卒中量表(NIHSS)评分(OR=1.291,95%CI:1.098~1.518)、高超敏C反应蛋白(OR=1.026,95%CI:1.005~1.047)、低受教育程度(OR=2.485,95%CI:1.231~5.018)是PACI后12~18个月出现VCI的独立危险因素(均P<0.05);与上述指标比较,诊断预测模型曲线下面积(AUC)最大,为0.828(95%CI:0.755~0.902)。结论高同型半胱氨酸、高糖化血红蛋白、高NIHSS评分、高超敏C反应蛋白、低受教育程度为PACI后12~18个月发生VCI的独立危险因素,通过诊断预测模型的应用有助于筛查VCI高危患者,及时给予临床关注和诊疗干预。Objeetive To investigate risk factors for vascular cognitive impairment(VCI)in elderly patients 12-18 months after the onset of acute partial anterior circulation infarction(PACI),and to establish a diagnostic and predictive model.Methods This was a prospective study.Demographic characteristics.vascular risk factors and laboratory data of 148 patients with acute PACI were collcted,and patients were followed up for 12-18 months.The Montreal Cognitive Assessment Scale(MoCA)was used to evaluate patients'cognitive function.Logistic stepwise regression was used to screen risk factors for VCL.We established a diagnostic and predictive model.The area under the receiver operating(ROC)curve(AUC)was used to evaluate the efficiency of the model.Results A total of 126 subects completed the 12-18 month follow-up.Multivariate logistic regression analysis found that high homocysteine(Hcy)(OR=1.082.95%CI:1.002-1.167).high glycated he moglobin(HbAlc)(OR=1.653.95%CI:1.052-2.598),high National Institutes of Health Stroke Scale(NIHSS)score(OR=1.291.95%CI:1.098-1.518).high hypersensitive C reactive protein(hs-CRP)(OR=1.026.95%CI:1.005-1.047)and low education level(OR=2.485.95%CI:1.231-5.018)were independent risk factors for VCI in patients 12-18 months after PACI(P<0.05).The AUC of the diagnostic and predictive model was 0.828(95%CI:0.755-0.902).Conclusions High Hcy,NIHSS score,hs-CRP and low education level are independent risk factors for VCI in patients 12-18 months after PACI.The diagnostic and predictive model can help to screen patients at high-risk for VCI,so that timely clinical recognition,diagnosis and treatment can be made after acute PACI.

关 键 词：认知障碍 梗死 预测模型 

分 类 号：R749.13[医药卫生—神经病学与精神病学] R743.3[医药卫生—临床医学]