载脂蛋白E联合临床相关指标预测阿尔兹海默病模型的建立与验证  

Apolipoprotein ApoE Combined with Clinical Related Indices to Predict and Verify a Model for Alzheimer′s Disease

作　　者：吴天晨[1] 杨卉[2] 梁艳[1] 杨永刚 Wu Tianchen;Yang Hui;Liang Yan(Nanjing Hospital of Traditional Chinese Medicine 210022,Nanjing)

机构地区：[1]南京市中医院,210001 [2]南京中医药大学

出　　处：《中国卫生统计》2024年第1期23-27,共5页Chinese Journal of Health Statistics

基　　金：国家自然科学基金(81904112);江苏省自然科学基金资助项目(BK20190136);南京市中医药青年人才培养项目(ZYQ20047)。

摘　　要：目的 以载脂蛋白E(ApoE)为基础,结合阿尔茨海默病发病危险因素及临床常见指标,构建阿尔兹海默病发病风险的临床预测模型。方法 从南京市中医院大数据平台中,检索时间为2019年1月至2021年1月两年时间内,阿尔兹海默病患者61例,模糊匹配健康体检者111例。利用LASSO回归筛选危险因素,构建logistic回归预测模型,10折交叉进行区分度验证,bootstrap法进行校准度验证,临床决策曲线评判预测模型的临床指导性,最后以列线图可视化呈现临床预测模型。结果 筛选出12个变量,最终纳入4个危险因素:年龄、游离三碘甲状腺素(FT3)、性别、ApoE。全样本ROC曲线下面积为0.879,10折交叉9次验证后ROC曲线下平均面积为0.864;采用Bootstrap法抽样及Hosmer-Lemeshow校准度检验,结果χ^(2)=6.496,P=0.592>0.05。临床决策曲线阈值概率区间为1%~88.6%。结论 利用年龄、游离三碘甲状腺素、性别、 ApoE构建的临床预测模型对患者进行个体化评估,可以预警阿尔兹海默病,开展早期预防干预,减缓该病的发生发展。Objective To construct a clinical prediction model for the risk of Alzheimer′s disease based on ApoE,combined with risk factors and common clinical indicators.Methods There were 61 cases of Alzheimer′s disease patients and 111 cases of fuzzy matching healthy physical examination from Nanjing Hospital of Chinese Medicine data platform from January 2019 to January 2021.Using LASSO regression screening of risk factors,constructing logistic regression forecasting model,10 fold cross verifies the degree of differentiation,validation the calibration of the bootstrap method.The clinical guidance of the prediction model was evaluated by the clinical decision curve,and finally,the clinical prediction model was visualized by nomogram.Results 12 variables were screened out and four risk factors were included,which are age,free triiodothyroxine(FT3),gender and ApoE.The AUC of ROC of the whole sample was 0.879,and the average AUC of ROC after 10 folded and 9 crossed training sets verification was 0.864.Bootstrap method and Hosmer-Lemeshow were used to test the calibration degree.Resultsχ^(2)=6.496,P=0.592>0.05.The threshold probability of clinical decision curve ranged from 1%to 88.6%.Conclusion Individualized evaluation of patients using clinical prediction models constructed by age,FT3,gender and ApoE can provide early warning of Alzheimer′s disease,carry out early prevention intervention and slow down the development of the disease.

关 键 词：痴呆 阿尔兹海默病 预测模型 载脂蛋白E 

分 类 号：R74[医药卫生—神经病学与精神病学]