维持性腹膜透析患者发生轻度认知障碍的影响因素分析及预测模型构建  

Analysis of influencing factors and prediction model construction for mild cognitive impairment in patients on maintenance peritoneal dialysis

作　　者：王加利 常红娟[1] 吕玉敏[2] 杨国玲 李强[2] 田娟娟 王丽娜 Wang Jiali;Chang Hongjuan;Lyu Yumin;Yang Guoling;Li Qiang;Tian Juanjuan;Wang Lina(School of Nursing,Xinxiang Medical University,Xinxiang Henan 453003,China;Department of Nephrology,The First Affiliated Hospital of Xinxiang Medical University,Xinxiang Henan 453100,China)

机构地区：[1]新乡医学院护理学院,河南新乡453003 [2]新乡医学院第一附属医院肾内科,河南新乡453100

出　　处：《保健医学研究与实践》2024年第12期69-75,共7页Health Medicine Research and Practice

基　　金：河南省科技发展项目(212102310671)。

摘　　要：目的探讨维持性腹膜透析(MPD)患者发生轻度认知障碍(MCI)的影响因素,并构建预测模型,旨在为临床早期识别高危人群并及时干预提供依据。方法选取2021年1月—2024年1月新乡医学院第一附属医院收治的MPD患者120例作为研究对象,根据认知功能筛查结果分为认知功能正常组(55例)和MCI组(65例)。比较2组患者一般资料和实验室指标,采用多因素logistic回归分析MPD患者发生MCI的影响因素,依据影响因素构建预测模型,并绘制受试者工作特征(ROC)曲线评价预测模型的预测效能。结果MCI组患者年龄≥60岁人数比例、文化程度为初中及以下人数比例、透析龄和有糖尿病史人数比例高于认知功能正常组(P<0.05)。MCI组患者前白蛋白(PAB)、全段甲状旁腺激素(iPTH)水平低于认知功能正常组,同型半胱氨酸(Hcy)水平高于认知功能正常组,差异均有统计学意义(P<0.05)。多因素logistic回归分析显示,年龄(OR=1.322,95%CI:1.080~1.617)、文化程度(OR=1.369,95%CI:1.099~1.705)、透析龄(OR=1.399,95%CI:1.135~1.726)、PAB(OR=1.505,95%CI:1.185~1.912)、Hcy(OR=1.527,95%CI:1.214~1.920)、iPTH(OR=1.516,95%CI:1.180~1.948)水平是MPD患者发生MCI的影响因素(P<0.05)。根据上述因素构建预测模型,模型表达式为:Logit P=-7.566+0.279×年龄+0.314×文化程度+0.336×透析龄+0.409×PAB+0.423×Hcy+0.416×iPTH。Hosmer-Lemeshow检验显示模型拟合度较高(P=0.604),预测模型的ROC曲线的曲线下面积(AUC)(95%CI)为0.939(0.895~0.982),敏感度为90.77%,特异度为89.09%。结论年龄、文化程度、透析龄及PAB、Hcy、iPTH水平与MPD患者发生MCI密切相关,根据影响因素构建的预测模型具有较好的预测效能,可为临床提供参考。Objective To explore the influencing factors of mild cognitive impairment(MCI)in patients on maintenance perito-neal dialysis(MPD)and construct a prediction model,aiming to provide a basis for early identification of high-risk populations and timely intervention in clinical settings.Methods A total of 120 MPD patients treated at the First Affiliated Hospital of Xinxiang Medical University from January 2021 to January 2024 were selected as study participants.Based on cognitive func-tion screening results,the patients were assigned to the cognitive function normal group(n=55)and the MCI group(n=65).General data and laboratory indicators of the two groups were compared.Multivariate logistic regression analysis was per-formed to determine the influencing factors of MCI in MPD patients.A prediction model was constructed based on these fac-tors,and the predictive performance of the model was evaluated using receiver operating characteristic(ROC)curves.Results The proportion of patients aged≥60 years,those with education level of junior high school or below,dialysis duration,and those with a history of diabetes were significantly higher in the MCI group than in the cognitive function normal group(P<0.05).The levels of prealbumin(PAB)and intact parathyroid hormone(iPTH)were significantly lower in the MCI group,while homocysteine(Hcy)levels were significantly higher than those in the cognitive function normal group(P<0.05).Mult-ivariate logistic regression analysis showed that age(OR=1.322,95%CI:1.080-1.617),education level(OR=1.369,95%CI:1.099-1.705),dialysis duration(OR=1.399,95%CI:1.135-1.726),PAB(OR=1.505,95%CI:1.185-1.912),Hcy(OR=1.527,95%CI:1.214-1.920),and iPTH(OR=1.516,95%CI:1.180-1.948)were influencing fac-tors for the occurrence of MCI in MPD patients(P<0.05).Based on these factors,the prediction model was constructed with the following expression:Logit P=-7.566+0.279×Age+0.314×Education level+0.336×Dialysis duration+0.409×PAB+0.423×Hcy+0.416×iPTH.The Hosmer-Lemeshow test showed good model fit(P=0.604).T

关 键 词：维持性腹膜透析 轻度认知障碍 LOGISTIC回归分析 预测模型 

分 类 号：R459.5[医药卫生—治疗学] R743[医药卫生—临床医学]