多因素综合血管性痴呆伴肺部感染患者发生营养不良预测模型的构建  

Establishment of a Multifactorial Model for Predicting Malnutrition in Patients with Vascular Dementia with Pulmonary Infection

作　　者：张金冉[1] 魏海梁 王庆庆[2] 曹绍华 ZHANG Jinran;WEI Hailiang;WANG Qingqing;CAO Shaohua(Department of Mental and Physical Health,Yan′an University Affiliated Hospital,Yan′an 716000,China;Department of Clinical Pharmacy,Yan′an University Affiliated Hospital,Yan′an 716000,China;Department of General Surgery,Affiliated Hospital of Shanxi University of Traditional Chinese Medicine,Xianyang 712000,China)

机构地区：[1]延安大学附属医院心身科,陕西延安716000 [2]延安大学附属医院临床药学科,陕西延安716000 [3]陕西中医药大学附属医院普外科,陕西咸阳712000

出　　处：《医学综述》2020年第24期4962-4967,共6页Medical Recapitulate

摘　　要：目的构建多因素综合血管性痴呆伴肺部感染患者发生营养不良的预测模型,并探讨其临床应用价值。方法选取2016年3月至2019年11月延安大学附属医院收治的131例血管性痴呆伴肺部感染患者作为研究对象,根据简易营养评价精法评分结果分为营养不良组(n=70)和营养正常组(n=61),并采用单因素分析两组患者一般资料,多因素分析构建血管性痴呆伴肺部感染患者发生营养不良的联合检测因子模型,绘制受试者工作特征曲线(ROC曲线),分析其临床应用价值。结果营养不良组丧偶、无家人照顾、卧床、厌食、鼻饲、呼吸衰竭、半年感染≥3次、抗生素使用比例和血红蛋白均高于营养正常组(P<0.05或P<0.01),简易智能精神状态检查量表评分、淋巴细胞计数、动脉氧分压均低于营养正常组[(17.11±2.57)分比(18.20±1.53)分,(1.35±0.52)×109/L比(1.67±0.29)×109/L,(72.13±5.11)mmHg(1 mmHg=0.133 kPa)比(73.85±2.07)mmHg](P<0.05或P<0.01)。Logistic回归分析结果显示,无家人照顾(OR=5.772,95%CI 1.128~29.538)、卧床(OR=1.929,95%CI 1.061~3.507)、半年感染≥3次(OR=6.560,95%CI 1.439~29.905)、抗生素使用(OR=1.735,95%CI 1.036~2.905)是影响血管性痴呆伴肺部感染患者发生营养不良的独立危险因素(均P<0.05);将患者的无家人照顾(X 1)、卧床(X 2)、半年感染≥3次(X 3)及抗生素使用(X 4)分别作为协变量,构建联合检测因子模型表达式为:Logit(P)=-4.773+1.753 X 1+0.657 X 2+1.881 X 3+0.551 X 4;该模型最佳临界值为0.451,灵敏度为87.93%,特异度为86.30%,准确度为87.02%,曲线下面积为0.855(95%CI 0.617~0.924)。结论多因素综合构建的血管性痴呆伴肺部感染患者发生营养不良联合检测因子模型对血管性痴呆伴肺部感染患者营养不良的发生具有较高的预测价值。Objective To establish a multifactorial predictive model of malnutrition in patients with vascular dementia and pulmonary infection,and to explore its clinical application value.Methods A total of 131 patients with vascular dementia and pulmonary infection admitted to Yan′an University Affiliated Hospital from Mar.2016 to Nov.2019 were included,and they were divided into a malnutrition group(n=70)and a normal nutrition group(n=61)according to the results of simple nutritional assessment.The general clinical data of the two groups were analyzed by single factor analysis,and the model of joint detection factor of malnutrition in patients with vascular dementia and pulmonary infection was constructed by multi factor analysis,and receiver operating characteristic curve(ROC curve)of the subjects was drawn to analyze its clinical application value.Results The widowhood,no family care,bedridden,anorexia,nasal feeding,respiratory failure,infection≥3 times in half a year,the proportion of patients with antibiotic use and hemoglobin in the malnutrition group were higher than those the in normal nutrition group(P<0.05 or P<0.01).The mini-mental state examination score,lymphocyte count and arterial oxygen partial pressure in the malnutrition group were lower than those in the normal nutrition group[(17.11±2.57)vs(18.20±1.53),(1.35±0.52)×109/L vs(1.67±0.29)×109/L,(72.13±5.11)mmHg vs(73.85±2.07)mmHg](P<0.05 or P<0.01).Logistic regression analysis showed that no family care(OR=5.772,95%CI 1.128-29.538),bedridden(OR=1.929,95%CI 1.061-3.507),infection≥3 times in half a year(OR=6.560,95%CI 1.439-29.905),antibiotic use(OR=1.735,95%CI 1.036-2.905)were independent risk factors for malnutrition in the patients with vascular dementia and pulmonary infection(all P<0.05).Taking family care(X 1),bedridden(X 2),infection≥3 times in half a year(X 3)and antibiotic use(X 4)as covariates,the expression of joint detection factor model was:Logit(P)=-4.773+1.753 X 1+0.657 X 2+1.881 X 3+0.551 X 4.The optimal critical value of the m

关 键 词：血管性痴呆 肺部感染 营养不良 预测模型 

分 类 号：R749.1[医药卫生—神经病学与精神病学] R563[医药卫生—临床医学]