社区老年2型糖尿病患者认知衰弱风险列线图预测模型的建立与验证  

Establishment and validation of a nomogram prediction model for cognitive frailty in community-dwelling elderly patients with type 2 diabetes mellitus

作　　者：杜瑾 张迪[1] 陈玉荣 张伟宏[3] Du Jin;Zhang Di;Chen Yurong;Zhang Weihong(The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China;Community Health Service Center of East Hanghai Road,Zhengzhou City,Zhengzhou 450009,China;School of Nursing and Health,Zhengzhou University,Zhengzhou 450001,China)

机构地区：[1]郑州大学第一附属医院,郑州450052 [2]郑州市航海东路社区卫生服务中心,郑州450009 [3]郑州大学护理与健康学院,郑州450001

出　　处：《中华行为医学与脑科学杂志》2024年第4期310-316,共7页Chinese Journal of Behavioral Medicine and Brain Science

基　　金：国家自然科学基金(72064038)。

摘　　要：目的:探讨社区老年2型糖尿病患者认知衰弱的影响因素,进行风险列线图预测模型的建立与验证。方法:采用便利抽样法于2021年8月—2022年5月选取527例郑州市航海东路社区的老年2型糖尿病患者,利用一般资料调查问卷、衰弱表型、蒙特利尔认知评估量表、临床痴呆评定量表、简版老年人抑郁量表、简易营养评价精法问卷以及阿森斯失眠量表进行调查。采用SPSS 21.0软件进行统计分析,采用多因素Logistic回归分析来确定社区老年2型糖尿病患者发生认知衰弱的影响因素。根据筛选的影响因素构建列线图预测模型,并验证模型的预测准确度及区分度。结果:527例社区老年2型糖尿病患者中发生认知衰弱有64例(12.1%)。年龄≥70岁、独居(B=1.645,P<0.001,OR=5.182,95%CI=2.623~10.237)、抑郁(B=1.135,P=0.001,OR=3.112,95%CI=1.572~6.161)、营养不良(B=0.987,P=0.005,OR=2.683,95%CI=1.355~5.310)、失眠(B=0.761,P=0.047,OR=2.141,95%CI=1.012~4.530)、糖化血红蛋白(HbA1c)≥8.5%(B=1.083,P=0.014,OR=2.954,95%CI=1.242~7.027)是2型糖尿病患者发生认知衰弱的危险因素;规律运动是保护因素(B=-0.982,P=0.002,OR=0.375,95%CI=0.203~0.690)。基于以上7项独立影响因素建立的列线图预测模型具有较好的准确度(H-L检验:χ^(2)=5.389,P=0.715)和区分度(AUC=0.790,95%CI=0.728~0.852)。结论:本次研究将认知衰弱的7项影响因素进行整合并依此构建的列线图预测模型具有较好的预测价值,可直观简便地识别具有认知衰弱高风险的社区老年2型糖尿病患者,为早期筛查和及时干预提供参考。Objective To explore the influencing factors of cognitive frailty in community-dwelling elderly patients with type 2 diabetes mellitus,and to establish and verify a nomogram prediction model.Methods A total of 527 elderly patients with type 2 diabetes mellitus in the community of East Hanghai Road,Zhengzhou City were selected by convenience sampling method from August 2021 to May 2022,and they were investigated by general information questionnaire,frailty phenotype,Montreal cognitive assessment scale,clinical dementia rating scale,geriatric depression scale,short-form mini-nutritional assessment and Athens insomnia scale.Multifactorial Logistic regression analysis was performed by SPSS 21.0 software to determine the influencing factors of cognitive frailty in community-dwelling elderly patients with type 2 diabetes mellitus.The nomogram prediction model was constructed based on the screened influencing factors,and the predictive accuracy and discrimination of the model were verified.Results The results showed that 64(12.1%)of 527 community-dwelling elderly patients with type 2 diabetes mellitus developed cognitive frailty.Age≥70 years,living alone(B=1.645,P<0.001,OR=5.182,95%CI=2.623-10.237),depression(B=1.135,P=0.001,OR=3.112,95%CI=1.572-6.161),malnutrition(B=0.987,P=0.005,OR=2.683,95%CI=1.355-5.310),insomnia(B=0.761,P=0.047,OR=2.141,95%CI=1.012-4.530),and glycosylated hemoglobin(HbA1c)≥8.5%(B=1.083,P=0.014,OR=2.954,95%CI=1.242-7.027)were risk factors for cognitive frailty in type 2 diabetes patients,while regular exercise was a protective factor(B=-0.982,P=0.002,OR=0.375,95%CI=0.203-0.690).Based on the above seven independent influencing factors,the nomogram prediction model established accordingly had good accuracy(H-L test:χ^(2)=5.389,P=0.715)and discrimination(AUC=0.790,95%CI=0.728-0.852).Conclusion The nomogram prediction model which is constructed by integrating the seven influencing factors of cognitive frailty has good predictive value,which can intuitively and easily identify community-dwelling eld

关 键 词：2型糖尿病 认知衰弱 社区 老年 列线图 预测模型 

分 类 号：R587.1[医药卫生—内分泌]