老年慢性阻塞性肺疾病患者认知衰弱风险筛查模型的构建及验证

doi:10.3761/j.issn.0254-1769.2022.15.010

摘要/Abstract

摘要：

目的调查老年慢性阻塞性肺疾病（chronic obstructive pulmonary disease,COPD）患者认知衰弱的现状,分析相关影响因素并构建风险筛查模型。方法便利选取2020年5月—2021年3月山西省某三级甲等医院呼吸内科、老年科收治的386例老年COPD患者作为训练集,根据是否发生认知衰弱分为认知衰弱组（n=123）和非认知衰弱组（n=263）。通过单因素分析和Logistic回归分析筛选老年COPD患者认知衰弱的影响因素,构建风险筛查模型。于2021年4月—7月选取同一所医院住院的158例老年COPD患者作为验证集,对模型进行外部验证。结果训练集认知衰弱发生率为31.9%,验证集为35.4%。年龄、是否每天进行智力活动、是否多病共存、病程、肺功能分级、PaCO₂是老年COPD患者认知衰弱的影响因素。风险筛查模型内部验证中,Hosmer-Lemeshow χ²检验P=0.328,受试者操作特征曲线下面积为0.813,约登指数为0.481,灵敏度为0.764,特异度为0.703。外部验证中,Hosmer-Lemeshow χ²检验P=0.468,受试者操作特征曲线下面积为0.886,灵敏度为0.732,特异度为0.824。结论老年COPD患者认知衰弱发生率较高,年龄≥70岁、未每天进行智力活动、多病共存、病程≥5年、肺功能分级>Ⅰ级、PaCO₂>50 mmHg（1 mmHg=0.133 kPa）的老年COPD患者发生认知衰弱的风险较高。该文构建的风险筛查模型具有良好的区分度和校准度,可为临床医护人员评估老年COPD患者认知衰弱的发生风险、制订护理对策提供参考。

关键词: 老年人, 肺疾病,慢性阻塞性, 认知衰弱, 影响因素分析, 模型,统计学, 护理

Abstract:

Objective This study was to investigate the status and risk factors of cognitive frailty in elderly patients with chronic obstructive pulmonary disease（COPD）,and to develop a risk screening model. Methods A total of 386 elderly patients with COPD hospitalized in the respiratory department and geriatric department of a tertiary hospital in Shanxi Province from May 2020 to March 2021 were selected and divided into a cognitive frailty group（n=123） and a non-cognitive frailty group（n=263）,according to their occurrence of cognitive frailty. Univariate analysis and multivariate Logistic regression were used to analyze the independent risk factors of cognitive frailty in elderly COPD patients. A risk screening model was established and the nomogram was drawn. From April to July 2021,158 elderly COPD patients from the same hospital were recruited for external validation. Results The incidences of cognitive frailty in training set and validation set were 31.9% and 35.4%,respectively. The multivariate regression analysis showed that age,daily intellectual activity,comorbidity,duration of disease,lung function grade and PaCO₂ were independent risk factors of cognitive frailty in elderly COPD patients. The H-L test P=0.328,and the AUC was 0.813. The Youden index was 0.481,with the sensitivity of 0.764 and the specificity of 0.703. While the external validation H-L test P=0.468,the AUC was 0.886 with the sensitivity of 0.732 and the specificity of 0.824. Conclusion The prevalence of cognitive frailty in elderly COPD patients is high;age≥70,non-dai-ly intellectual activity,comorbidity,duration of disease≥5 years,GOLD>Ⅰ and PaCO₂>50 mmHg（1 mmHg=0.133 kPa） can increase the risk of cognitive frailty in elderly COPD patients. This risk screening model has good differentiation and correction,which can provide references for clinic to screen the risk of cognitive frailty in elderly COPD patients and take effective nursing care.

Key words: Aged, Pulmonary Disease,Chronic Obstructive, Cognitive Frailty, Root Cause Analysis, Models,Statistics, Nursing Care

宋歌, 王颖, 高欢玲, 乔美荣, 陈玲, 杨玉霖. 老年慢性阻塞性肺疾病患者认知衰弱风险筛查模型的构建及验证[J]. 中华护理杂志, 2022, 57(15): 1859-1867.

SONG Ge, WANG Ying, GAO Huanling, QIAO Meirong, CHEN Ling, YANG Yulin. Construction and validation of a risk screening model for cognitive frailty in elderly patients with chronic obstructive pulmonary disease[J]. Chinese Journal of Nursing, 2022, 57(15): 1859-1867.

图/表 5

表1 训练集中老年慢性阻塞性肺疾病患者的一般资料及认知衰弱的单因素分析[例（百分比,%）]

Table 1 General information and univariate analysis of the risk of cognitive frailty in elderly patients with chronic obstructive pulmonary disease in the modeling set[cases（percentage,%）]

表2 老年慢性阻塞性肺疾病患者认知衰弱Logistic回归分析

Table 2 Logistic regression analysis of cognitive frailty in elderly patients with chronic obstructive pulmonary disease

图1 老年慢性阻塞性肺疾病患者认知衰弱风险列线图注：1 mmHg=0.133 kPa。

Figure 1 Nomogram of risk of cognitive frailty in elderly patients with chronic obstructive pulmonary disease

图2 训练集中老年慢性阻塞性肺疾病患者风险筛查模型的受试者操作特征曲线

Figure 2 Receiver operator characteristic curve in elderly patients with chronic obstructive pulmonary disease of the modeling set

图3 验证集中老年慢性阻塞性肺疾病患者风险筛查模型的受试者操作特征曲线

Figure 3 Receiver operator characteristic curve in elderly patients with chronic obstructive pulmonary disease of the validation set

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