脑卒中后认知障碍风险预测模型的系统评价  

Risk prediction models for post⁃stroke cognitive impairment:a systematic review

作　　者：张杰[1] 席崇程 孔云 钟克龙 安雪梅[2] ZHANG Jie;XI Chongcheng;KONG Yun;ZHONG Kelong;AN Xuemei Chengdu(University of Traditional Chinese Medicine,Sichuan 611137 China)

机构地区：[1]成都中医药大学,四川611137 [2]成都中医药大学附属医院

出　　处：《护理研究》2024年第10期1726-1733,共8页Chinese Nursing Research

基　　金：四川省自然科学基金项目,编号:2023NSFSC1811。

摘　　要：目的:系统评价脑卒中后认知障碍的风险预测模型。方法:检索中国知网、万方数据库、维普网、中国生物医学文献服务系统、PubMed、EMbase、the Cochrane Library、Web of Science和EBSCO数据库中的脑卒中后认知障碍风险预测模型相关研究,检索时限为建库至2023年1月30日。由2名研究者独立筛选文献、提取资料并评价纳入研究的偏倚风险和适用性。结果:共纳入16项研究,包括19个脑卒中后认知障碍风险预测模型,其中,16个模型采用了Logistic回归分析方法,2个模型采用了随机森林的方法,1个模型采用了LASSO回归的方法。建模时受试者工作特征曲线下面积(AUC)为0.773~0.940。4个模型进行了Hosmer-Lemeshow(H-L)检验,其中2个模型报告了P值且P≥0.05。11个模型进行了内部验证,5个模型进行了外部验证,4个模型同时进行了内部验证和外部验证。16项研究适用性较好,但存在较高的偏倚风险,主要问题集中在分析领域。结论:脑卒中后认知障碍风险预测模型整体性能良好,但模型质量有待提高,在未来的研究中需优化研究设计、扩大样本量、根据临床需要选择合适的预测因子、改进统计分析方法,并注重模型的外部验证,以验证模型的泛化能力。Objective:To systematically evaluate the risk prediction models for post-stroke cognitive impairment.Methods:Research related to risk prediction models for post-stroke cognitive impairment was retrieved from China National Knowledge Infrastructure,Wanfang Data,China Biology Medicine database,PubMed,EMbase,the Cochrane Library,Web of Science,and EBSCO.The retrieval period was from establishment of databases to January 30,2023.2 researchers independently screened the literature,extracted data,and evaluated the risk of bias and applicability for inclusion in the study.Results:A total of 16 studies were included,including 19 risk prediction models for post-stroke cognitive impairment.Among them,16 models used Logistic regression analysis,2 models used random forest method,and 1 model used LASSO regression method.The area under the curve(AUC)of receiver operator characteristic during modeling were ranged from 0.773 to 0.940.4 models were subjected to the Hosmer-Lemeshow(H-L)test,with 2 models reported P-values and their P≥0.05.11 models underwent internal validation,5 models underwent external validation,and 4 models underwent both internal and external validation simultaneously.The 16 studies had good applicability,but there was a high bias,and the main problem was concentrated in the analysis field.Conclusions:The overall performance of the risk prediction models for post-stroke cognitive impairment is good,but the quality of the models need to be improved.In future research,it is necessary to optimize the research design,expand the sample size,select appropriate predictive factors according to clinical needs,improve statistical analysis methods.It also should focus on external validation of the model to verify its generalization ability.

关 键 词：脑卒中后认知障碍 风险预测 模型 质量评价 循证护理 

分 类 号：R473.74[医药卫生—护理学]