老年抑郁症重度发作简易预测模型的构建及其预测价值  

Construction of a simple prediction model for severe late-life depression and its predictive value

作　　者：王晶[1] 吴彦 刘娜 叶思聪 陈佳雨 赵黎萍[1] WANG Jing;WU Yan;LIU Na(Baoshan District Mental Health Center in Shanghai,Shanghai 201900,China)

机构地区：[1]上海市宝山区精神卫生中心,上海201900 [2]上海交通大学医学院附属精神卫生中心.

出　　处：《国际精神病学杂志》2025年第1期148-152,共5页Journal Of International Psychiatry

基　　金：上海市宝山区卫生健康委员会科研课题计划(编号:BSZK-2023-BP10);上海市宝山区卫生健康系统英才(优秀学科带头人)培养计划资助(BSWSYX-2024-07)。

摘　　要：目的老年抑郁症(LLD)尤其是重度发作可能会增加自杀的风险,因此需要构建能够快速识别LLD重度发作的预测模型来提高早期识别率。方法选取2021年1月~2023年6月期间在上海市宝山区精神卫生中心就诊的LLD患者为调查对象,进行量表评估和血液学检测,采用Logistic回归分析探讨LLD重度发作的影响因素,用Risk score法构建LLD重度发作简易预测模型,并检验其预测效果。结果共有402例LLD纳入研究,378例被试完成基线调查和血液检测,其中重度发作有93例(24.60%)。多因素Logistic回归分析结果显示HAMA总分[OR=1.218,95%CI(1.161~1.278)]、IL-6[OR=1.009,95%CI(1.002~1.017)]、LDL[OR=1.701,95%CI(1.213~2.385)]均是LLD重度发作的危险因素(P<0.05或P<0.001)。基于Logistic回归建立的Risk score预测模型为:Risk Score=IL-6+21.89 HAMA+59 LDL,该模型ROC曲线下面积(AUC)为0.922(P<0.001,95%CI=0.892~0.951)。约登指数最大时为0.735,截断值为705.165分,灵敏度为90.3%,特异度为83.2%。结论LLD患者重度发作比率较高,HAMA总分、IL-6和LDL是其危险因素,基于Logistic回归建立的Risk score预测模型预测LLD重度发作的灵敏度为90.3%,特异度为83.2%。Objective The clinical manifestations of late-life depression(LLD)are atypical and the recognition rate is relatively low in clinical practice.Especially,severe depression may increase the risk of suicide.Therefore,it is necessary to construct a prediction model that could quickly identify severe late-life depression to improve the early recognition rate.Methods Late-life depression who attended the Mental Health Center of Baoshan District,Shanghai from January 2021 to June 2023 were selected as the survey subjects.Scale assessment and hematological tests were conducted.Logistic regression analysis was used to explore the influencing factors of severe late-life depression.The Risk Score method was used to construct a simple prediction model for severe late-life depression and test the predictive effect.Results A total of 402 late-life depression were included in the study.378 subjects completed the baseline survey and blood tests,among which 93 cases(24.60%)had severe episodes.The results of multivariate logistic regression analysis showed that the total score of HAMA[OR=1.218,95%CI(1.161-1.278)],interleukin-6[OR=1.009,95%CI(1.002-1.017)],and LDL[OR=1.701,95%CI(1.213-2.385)]were all risk factors for severe late-life depression(P<0.05 or P<0.001).The Risk Score prediction model based on logistic regression was Risk Score=IL-6+21.89 HAMA+59 LDL,and the area under the ROC curve(AUC)of this model was 0.922(P<0.001,95%CI=0.892~0.951).The Jordon's index was 0.735 at its maximum,and the cut-off value was 705.165 points with a sensitivity of 90.3%and a specificity of 83.2%.Conclusion The rate of severe late-life depression is relatively high.The total score of HAMA,interleukin-6 and low-density lipoprotein are the risk factors.The Risk Score prediction model based on logistic regression prognosed severe late-life depression with a sensitivity of 90.3%and a specificity of 83.2%.

关 键 词：老年抑郁症 重度发作 危险因素 预测模型 

分 类 号：R749.4[医药卫生—神经病学与精神病学]