基于中医证候要素的脑小血管病轻度认知障碍预测模型构建  

Construction of A Prediction Model for Mild Cognitive Impairment in Cerebral Small Vessel Disease Based on Traditional Chinese Medicine Syndrome Elements

作　　者：李施新 段佳钰 靳会会 王业飞 宋佳乐 李晓杉 金香兰 LI Shixin;DUAN Jiayu;JIN Huihui;WANG Yefei;SONG Jiale;LI Xiaoshan;JIN Xianglan(Beijing University of Chinese Medicine,Beijing 100029,China;The Second Clinical Medical College of Beijing University of Chinese Medicine,Beijing 100078,China)

机构地区：[1]北京中医药大学,北京100029 [2]北京中医药大学第二临床医学院,北京100078

出　　处：《中医药导报》2025年第3期95-100,共6页Guiding Journal of Traditional Chinese Medicine and Pharmacy

基　　金：中华中医药学会研究与评价专项课题(CACMRE2021-A-06);北京市中医药科技发展基金重点项目(BJZYZD-2023-05);北京中医药大学2020年度基本科研业务费项目任务书重点攻关项目(2020-JYB-ZDGG-124)。

摘　　要：目的:构建基于中医证候要素的脑小血管病(CSVD)轻度认知障碍预测模型,旨在为CSVD相关认知障碍的风险人群进行早期识别提供依据。方法:采用便利抽样法前瞻性纳入312例CSVD患者。应用因子分析提取证候要素,根据MoCA和MMSE量表评估认知功能并分组,通过单因素、LASSO回归及Logistic回归分析影响CSVD轻度认知障碍的证候要素变量,构建基于证候要素的CSVD轻度认知障碍预测模型。采用似然比卡方、Wald卡方、拟合优度检验评估模型,受试者工作特征(ROC)曲线评价模型预测价值。结果:312例CSVD患者轻度认知障碍的发生率为59.6%;校正年龄、高血压病、HDL-C水平、腔隙≥1等变量后,气虚证[OR=1.039,95%CI(1.006~1.073)]、痰湿证[OR=5.759,95%CI(2.527~13.125)]、血瘀证[OR=4.512,95%CI(1.874~10.861)]是CSVD患者认知障碍的影响因素;利用上述指标构建基于中医证候要素的CSVD轻度认知障碍预测模型,ROC曲线显示,曲线下面积(AUC)值为0.834,95%CI为0.789~0.879,敏感度为66.7%,特异度为88.1%。结论:基于气虚、痰湿、血瘀证候要素构建的模型对CSVD轻度认知障碍具有一定预测价值;此模型可较早地对CSVD相关认知障碍进行预测,为CSVD相关认知障碍的风险人群进行早期识别提供依据。Objective:To construct a mild cognitive impairment prediction model for cerebral small vessel disease(CSVD)based on traditional Chinese medicine syndrome elements,aiming to provide a basis for early identification of risk populations with CSVD related cognitive impairment.Methods:Convenience sampling was used to prospectively include 312 CSVD patients.Factor analysis was applied to extract syndrome elements,and MoCA and MMSE scales were used to evaluate cognitive function.Single factor,Lasso regression,and Logistic regression were used to analyze the variables of syndrome elements that affect mild cognitive impairment in CSVD,and a CSVD mild cognitive impairment prediction model based on syndrome elements was constructed.The likelihood ratio chi square,Wald chi square,and goodness of fit test were used to evaluate the predictive value of the model,and the receiver operating characteristic(ROC)curve was used to evaluate the predictive value of the model.Results:The incidence of mild cognitive impairment in 312 CSVD patients was 59.6%.After adjusting for variables such as age,hypertension,HDL-C levels,and lacunar≥1,Qi deficiency syndrome[OR=1.039,95%CI(1.006~1.073)],phlegm dampness syndrome[OR=5.759,95%CI(2.527~13.125)],and blood stasis syndrome[OR=4.512,95%CI(1.874~10.861)]were identified as influencing factors for cognitive impairment in CSVD patients.Using the above indicators to construct a CSVD mild cognitive impairment prediction model based on traditional Chinese medicine syndrome elements,the ROC curve showed that the area under the curve(AUC)value was 0.834,the 95%CI was 0.789~0.879,the sensitivity was 66.7%,and the specificity was 88.1%.Conclusions:The model constructed based on the elements of qi deficiency,phlegm dampness,and blood stasis syndrome has certain predictive value for mild cognitive impairment in CSVD.This model may predict CSVD related cognitive impairment earlier,providing a basis for early identification of risk populations for CSVD related cognitive impairment.

关 键 词：脑小血管病 认知障碍 证候要素 预测模型 

分 类 号：R241[医药卫生—中医诊断学]