分离性障碍患者高认知闭合需要风险预警模型构建与验证  

The construction and verification of risk warning model required for high cognitive closure in patients with dissociative disorders

作　　者：陈雪英 陈晶 冯彩琴 沈藕英 CHEN Xueying;CHEN Jing;FENG Caiqin;SHEN Ouying(Department of Geriatric Psychiatric,Shaoxing Seventh People’s Hospital,Shaoxing 312000,China;Department of Psychiatry,Shaoxing Seventh People’s Hospital,Shaoxing 312000,China;Department of Rehabilitation,Shaoxing Seventh People’s Hospital,Shaoxing 312000,China;Department of Intensive Psychiatric,Shaoxing Seventh People’s Hospital,Shaoxing 312000,China)

机构地区：[1]绍兴市第七人民医院老年精神科,浙江绍兴312000 [2]绍兴市第七人民医院精神科,浙江绍兴312000 [3]绍兴市第七人民医院康复科,浙江绍兴312000 [4]绍兴市第七人民医院重症精神科,浙江绍兴312000

出　　处：《温州医科大学学报》2024年第11期906-912,共7页Journal of Wenzhou Medical University

基　　金：浙江省医药卫生科技计划项目(2023KY1272)。

摘　　要：目的:探讨分离性障碍患者认知闭合需要的相关因素,描绘列线图风险预警模型并进行验证。方法:选取2020年1月至2022年9月绍兴市第七人民医院186例分离性障碍患者作为研究对象,依据患者认知闭合需要得分的高低分为低认知闭合需要组和高认知闭合需要组,使用Logistic回归对相关因素进行分析,构建列阵图风险模型并进行验证,同时纳入2022年9月至2023年8月本院的81例分离性障碍作为模型进行外部验证。结果:认知闭合需要总分为(218.74±30.46)分,高认知闭合需求的患者占72.04%。Logistic回归分析结果显示,人格特质、文化程度、发作次数、临床表现形式、父母教育方式是分离性障碍患者高认知闭合需要的影响因素(P<0.05)。以此构建的风险预测模型的Hosmer-Lemeshow拟合优度检验显示模型对数据的拟合度较好,预测能力较为可靠(P=0.176);ROC曲线下面积为0.810(95%CI=0.808~0.919,P<0.001),灵敏度为70.1%,特异性为86.5%;验证组Hosmer-Lemeshow拟合优度检验显示模型对数据的拟合度较好,预测能力较为可靠(P=0.637);ROC曲线下面积为0.883(95%CI=0.812~0.954,P<0.001),灵敏度为75.4%,特异性为87.5%。两预测模型的校正曲线总体趋势与理想曲线基本吻合。结论:本研究构建的分离性障碍患者发生高认知闭合需要的风险预测模型具有良好的预测效果,可为临床预防及干预提供参考依据,有效降低高认知闭合需要的水平。Objective:To explore the factors related to the need for cognitive closure in patients with dissociative disorders,and to depict and validate a risk prediction model of column-line diagram.Methods:A total of 186 cases with dissociative disorders in the Seventh People’s Hospital of Shaoxing from January 2020 to September 2022 were selected and divided as the low cognitive closure need group and the high cognitive closure need group based on their cognitive closure need scores.The Logistic regression was used to analyze the related factors,and the column-line diagram risk model was constructed and validated.An additional 81 patients with dissociative disorders in our hospital from September 2022 to August 2023 were included for external validation.Results:The total score of cognitive closure need was(218.74±30.46),with 72.04%of patients having a high cognitive closure need.The Logistic regression analysis showed that personality traits,literacy level,number of episodes,form of clinical presentation,and parental education were influence factors for high cognitive closure need in patients with dissociative disorders(P<0.05).The Hosmer-Lemeshow goodness-of-fit test indicated that the model had a good fit to the data and reliable predictive power(P=0.176).The area under the ROC curve was 0.810(95%CI=0.808-0.919,P<0.001),with sensitivity being 70.1%and specificity being 86.5%.The Hosmer-Lemeshow goodness-of-fit test for the validation group also demonstrated a good fit and reliable predictive power(P=0.637).The area under the ROC curve for the validation group was 0.883(95%CI=0.812-0.954,P<0.001),with sensitivity being 75.4%and specificity being 87.5%.The calibration curves of both prediction models were in close agreement with the ideal curve.Conclusion:The risk prediction model constructed in this study for high cognitive closure need in patients with dissociative disorders has good predictive performance,which provides a useful reference for clinical prevention and intervention strategies and can effectively reduc

关 键 词：分离性障碍患者 认知闭合 列线图 风险预测 影响因素 

分 类 号：R749.05[医药卫生—神经病学与精神病学]