2020-2022年中国临床诊断散发型克雅病患者的生存时间及影响因素分析  

Survival time and influencing factors analysis of clinically diagnosed sporadic Creutzfeldt-Jakob disease patients in China from 2020 to 2022

作　　者：张卫卫 梁冬林 周冬花 王远 肖康[2] 周伟[2] 董小平[2] 石琦[2] Zhang Weiwei;Liang Donglin;Zhou Donghua;Wang Yuan;Xiao Kang;Zhou Wei;Dong Xiaoping;Shi Qi(School of Public Health,North China University of Science and Technology,Tangshan 063210;National Key Laboratory of Intelligent Tracking and Forecasting for Infectious Diseases,National Institute of Viral Diseases,Chinese Center for Disease Control and Prevention,Beijing 102206)

机构地区：[1]华北理工大学公共卫生学院,唐山063210 [2]中国疾病预防控制中心病毒病预防控制所,传染病溯源预警与智能决策全国重点实验室,北京102206

出　　处：《安徽医科大学学报》2024年第10期1842-1848,共7页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金项目(编号:81630062);国家重点研发计划项目(编号:2020YFE0205700)。

摘　　要：目的了解2020-2022年中国临床诊断散发型克雅病患者的生存时间,探讨其影响因素。方法回顾性分析2020-2022年经中国克雅病监测网络诊断的有完整信息散发型克雅病临床诊断病例,从病例档案中获得患者的基线资料,电话随访获得患者确诊后的治疗及生存状况,寿命表法估算生存率,Kaplan-Meier法计算中位生存时间和95%CI,Cox回归模型进行单因素和多因素分析,筛选生存时间的影响因素。结果300例患者的中位生存时间为5个月(95%CI:4.165~5.835)。通过单因素分析结果显示,患者的发病年龄、地区分布、首发症状中有无锥体/锥体外系症状、首发症状的数量、临床表现有无锥体/锥体外系功能异常、主要临床表现的数量、临床检查结果有无典型脑电图表现、病程中是否使用鼻饲,这些因素可能是患者生存时间的影响因素(P<0.1)。多因素分析结果显示,发病年龄>65岁的患者死亡风险是发病年龄≤65岁患者的1.350倍(P=0.021,95.0%CI:1.046~1.742);临床表现无锥体/锥体外系功能异常患者的死亡风险是有此症状患者的0.674倍(P=0.020,95.0%CI:0.483~0.939);未使用鼻饲患者的死亡风险是使用鼻饲患者的1.817倍(P<0.001,95.0%CI:1.406~2.349)。结论发病年龄、临床表现锥体或锥体外系功能异常、病程中未使用鼻饲,是影响临床诊断散发型克雅病患者生存时间的风险因素。Objective To investigate the survival time of patients diagnosed with sporadic Creutzfeldt-Jakob disease in China between 2020 and 2022 and explore the associated factors influencing survival.Methods A retrospective analysis was conducted on clinically diagnosed cases with complete information on sporadic Creutzfeldt-Jakob disease diagnosed by the China Creutzfeldt-Jakob disease surveillance network from 2020 to 2022,baseline information of patients was obtained from the case files,telephone follow-up was used to obtain the treatment and survival status of the patients after the diagnosis,life-table method was used for estimating the survival rate,Kaplan-Meier method was used for calculating the median survival time and the 95%CI,Cox regression model was used for univariate and multivariate analyses were used to screen for factors influencing survival time.Results The median survival time of the 300 patients was 5 months(95%CI:4.165-5.835).Univariate analysis revealed that factors such as age at onset,regional distribution,presence of corticobasal or extrapyramidal symptoms as initial manifestations,number of initial symptoms,presence of corticobasal or extrapyramidal functional abnormalities,number of major clinical manifestations,presence of typical electroencephalogram findings,and use of nasal feeding during the course of the disease were potential factors influencing survival time(P<0.1).Multivariate analysis showed that the risk of death in patients with onset age>65 years was 1.350 times higher than in patients with onset age≤65 years(P=0.021,95.0%CI:1.046-1.742).Patients without pyramidal or extrapyramidal dysfunction had a 0.674-fold lower risk of death compared to those with these symptoms(P=0.020,95.0%CI:0.483-0.939).Patients who did not receive nasal feeding had a 1.817-fold higher risk of death compared to those who did(P<0.001,95.0%CI:1.406-2.349).Conclusion Age at onset,the presence of pyramidal or extrapyramidal functional abnormalities,and the use of nasal feeding during the disease course are

关 键 词：散发型克雅病 朊病毒 生存分析 影响因素 COX比例风险回归模型 

分 类 号：R182.2[医药卫生—流行病学]