精神分裂症患者再入院危险因素分析与风险预测模型构建  

Analysis of risk factors and construction of risk prediction model for readmissionof schizophrenic patients

作　　者：侯明如 王军[2] 薛建华 李现文[4] 陈琼妮[5] HOU Ming-ru;WANG Jun;XUE Jian-hua;LI Xian-wen;CHEN Qiong-ni(Department of General Psychiatry,The Affiliated Mental Health Center of Jiangnan University,Wuxi,Jiangsu 214151,China)

机构地区：[1]江南大学附属精神卫生中心,江苏无锡214151 [2]江南大学附属精神卫生中心临床心理科,江苏无锡214151 [3]华东疗养院科教处 [4]南京医科大学护理学院 [5]中南大学湘雅二医院临床护理学教研室,湖南长沙410011

出　　处：《现代预防医学》2024年第5期797-802,835,共7页Modern Preventive Medicine

摘　　要：目的 探讨精神分裂症患者出院一年内再入院的危险因素并构建再入院风险预测模型。方法 采用整群抽样,从住院电子病历和出院随访系统中获得某大型精神病院2020年7—12月住院精神分裂症患者353例,基于其人口学和临床资料采用logistic回归分析出院一年内再入院的危险因素,构建与评价再入院风险预测模型并进行内部验证。结果最终纳入4个预测因子:病程≥20年(OR=2.373, 95%CI:1.242~4.533)、抗精神病联合用药(OR=2.07, 95%CI:1.211~3.538)、合并基础疾病(OR=1.893, 95%CI:1.111~3.226)、危害性行为(OR=11.219, 95%CI:5.544~22.701)。所构建的预测模型拟合良好(χ^(2)=3.444, P=0.903),受试者工作特征曲线下面积为0.805,灵敏度为82.6%,特异度为65.6%。经Bootstrap重抽样(n=1 000次)结果显示模型稳定性良好。结论 基于人口学和临床资料构建的预测模型可作为早期识别精神分裂症患者再入院高风险的工具。Objective To explore the risk factors of re-admission of schizophrenic patients within one year after discharge and to establish a risk prediction model of re-admission.Methods By using cluster sampling,353 inpatients with schizophrenia in a large mental hospital from July to December 2020 were collected from the in-patient electronic medical record and discharge follow-up system.Based on their demographic and clinical data,Logistic regression analysis was used to analyze the risk factors of re-admission within one year after discharge.Results Four predictive factors were included:course of disease≥20 years(OR=2.373,95%CI:1.242-4.533),combination of antipsychotics(OR=2.07,95%CI:1.211-3.538),underlying disease(OR=1.893,95%CI:1.111-3.226),and harmful behavior(OR=11.219,95%CI:5.544-22.701).The prediction model fitted well(χ^(2)=3.444,P=0.903):the area under the receiver operating characteristic curve of the subjects was 0.805,the sensitivity was 82.6%,and the specificity was 65.6%.The results of Bootstrap re-sampling(n=1000 times)showed that the model was stable.Conclusion The predictive model based on demographic and clinical data can be used as a tool to identify the schizophrenic patients at high risk of re-admission in the early stage.

关 键 词：精神分裂症 精神病再入院 危险因素 风险预测模型 预防 

分 类 号：R749.3[医药卫生—神经病学与精神病学] R181.3[医药卫生—临床医学]