基于共享随机效应模型的纵向认知标志物对轻度认知障碍逆转的预测性能比较  

Comparison of Predictive Performance for Different Longitudinal Cognitive Markers in the Reversion of Mild Cognitive Impairment based on the Shared Random-Effect Model

作　　者：秦瑶 韩红娟 刘龙 陈杜荣 马艺菲 崔靖 白文琳 张荣 余红梅 Qin Yao;Han Hongjuan;Liu Long(Department of Health Statistics,Public Health of School,Shanxi Medical University(030001),Taiyuan)

机构地区：[1]山西医科大学公共卫生学院卫生统计学教研室,030001 [2]山西医科大学基础医学院数学教研室 [3]山西医科大学公共卫生学院儿少卫生学教研室 [4]重大疾病风险评估山西省重点实验室

出　　处：《中国卫生统计》2024年第3期370-375,共6页Chinese Journal of Health Statistics

基　　金：国家自然科学基金面上项目(81973154);山西省应用基础研究计划青年项目(201801D221399)。

摘　　要：目的将共享随机效应模型(shared random-effect model,SREM)应用于轻度认知障碍(mild cognitive impairment,MCI)向认知正常(normal cognition,NC)逆转的研究,比较不同纵向认知标志物对MCI逆转的预测性能,并评价影响因素的协变量效应。方法SREM模型包括两个子模型,其中纵向子模型采用线性混合效应模型对纵向认知标志物的变化轨迹建模,生存子模型采用比例风险模型对生存过程建模。基于对数似然函数值和信息准则进行模型拟合优度检验,采用ROC曲线下面积(area under the curve,AUC)评价不同纵向认知标志物(MMSE、CDRSB、FAQ、ADAS11、ADAS13和ADASQ4)对MCI逆转的预测性能;同时进行纵向子模型和生存子模型的影响因素分析。结果843名MCI患者中72名(8.54%)在随访结束后逆转为NC。以spline-PH-GH参数分布为基准风险函数的SREM模型对数似然函数值最大,AIC和BIC最小;以CDRSB为纵向认知标志物建立的SREM模型拟合最好,在不同时间的AUC值均表现良好,范围为0.797~0.852,且预测误差最小,范围为0.0427~0.0429;年龄、性别、受教育程度、婚姻状况和APOEε4基因均会影响MCI患者的认知功能和日常活动功能,六种纵向认知标志物均会影响MCI患者的逆转。结论CDR评分对MCI患者的认知功能和逆转预测性能最佳;认知功能和日常活动功能可作为MCI逆转的动态监测指标。Objective The shared random-effect model(SREM)was applied to study the reversion of mild cognitive impairment(MCI)to normal cognition(NC),to compare the predictive performance of different longitudinal cognitive markers for the reversion,and to evaluate the covariate effects of predictors.Methods The SREM model consisted of two sub-models:the longitudinal sub-model adopted linear mixed model to describe different longitudinal cognitive markers trajectories;and the survival sub-model used proportional risk model to fit the survival process.Goodness of fit was based on the log-likelihood value,and information criterion.AUC(area under the curve)was used to evaluate the predictive performance of different longitudinal cognitive markers,including MMSE,CDRSB,FAQ,ADAS11,ADAS13 and ADASQ4.Results There were 72(8.54%)of 843 patients with MCI reversed to NC at the end of follow-up.The log-likelihood value of the SREM model based on spline-PH-GH parameter distribution was the largest,and AIC and BIC were the smallest;the SREM model based on CDRSB score as longitudinal cognitive marker had the best fitting performance,with high AUC values at different times ranging from 0.797 to 0.852,and the lowest prediction error,ranging from 0.0427 to 0.0429.Age,gender,education level,marital status and APOEε4 gene affected the cognitive function and daily activity function.Six different longitudinal cognitive markers influenced the reversion.Conclusion CDR score was the best predictor of cognitive function and the reversion in MCI patients.Cognitive function and daily activity function can be used as dynamic monitoring indicators of MCI reversion.

关 键 词：共享随机效应模型 联合模型 纵向数据 生存数据 轻度认知障碍 逆转 

分 类 号：R195.1[医药卫生—卫生统计学]