摘要
目的 探讨原发性脑出血患者并发认知功能障碍的影响因素,构建预测模型并验证。方法 采用便利抽样法,回顾性分析2019年6月至2022年6月南京医科大学第一附属医院神经外科收治的195例原发性脑出血患者的资料。所有患者出院后均随访≥6个月,采用蒙特利尔认知评估量表(MoCA)、简易精神状态检查(MMSE)在随访期间评估患者的认知功能,根据MoCA评分分为并发认知障碍组(n=120)和未并发认知障碍组(n=75)。采用二项Logistic回归分析筛选原发性脑出血患者并发认知障碍的影响因素,并构建列线图预测模型,使用一致性系数(C-index)和校准曲线评估列线图模型的预测效能和符合度。结果 两组患者的年龄、文化程度、出院时美国国立卫生院卒中量表(NIHSS)评分、合并癫痫、合并去骨瓣减压、重症监护情况、出血部位比较,差异有统计学意义(P<0.05)。二项Logistic回归分析结果显示,年龄>60岁(OR=4.689,95%CI=1.420~15.470,P=0.011)、有癫痫病史(OR=3.007,95%CI=1.270~7.118,P=0.012)、出院NIHSS评分>15分(OR=2.699,95%CI=1.257~5.797,P=0.011)是原发性脑出血患者并发认知障碍的危险因素;文化程度初中及以上(OR=0.382,95%CI=0.159~0.913,P=0.030)、出血部位为顶枕叶(OR=0.105,95%CI=0.019~0.579,P=0.010)是原发性脑出血患者并发认知障碍的保护因素。模型验证结果显示,列线图预测模型的一致性指数为0.785,校准曲线与理想曲线走势相对一致,该模型有较好的准确度和符合度。结论 年龄大,文化程度低,出院NHISS评分高,有癫痫病史,脑干、基底节丘脑区、额颞叶区出血的原发性脑出血患者易并发卒中后认知功能障碍,基于上述变量构建的列线图模型预测效能较高。
Objective To explore the influencing factors of cognitive dysfunction in patients with primary cerebral hemorrhage and establish a predictive model and validate it. Methods Using convenience sampling method, 195 patients with primary cerebral hemorrhage who were admitted to the Department of Neurosurgery, the First Affiliated Hospital of Nanjing Medical University from June 2019 to June 2022 were retrospective analyzed. All patients were followed up for over 6 months after discharge. All patients were assessed by Montreal Cognitive Assessment (MoCA) and Mini-Mental State Examination (MMSE) for cognitive function. The patients were divided into the cognitive dysfunction group (n=120) and the non-cognitive impairment group (n=75). Binomial Logistic regression analysis was used to determine the influencing factors for cognitive dysfunction in patients with primary cerebral hemorrhage. According to the results of the analysis, a nomogram prediction model was constructed. The consistency coefficient (C-index) and calibration curve were used to evaluate the prediction efficiency and compliance of the nomogram model. Results The differences in age, education, National Institutes of Health Stroke Scale (NIHSS) score at the time of discharge, comorbid epilepsy,comorbid debridement, comorbid insular sign or high number of satellite foci, status of intensive caregiver, and distribution of bleeding sites were statistically significant when compared between the two groups (P < 0.05). Binomial Logistic regression analysis showed that age > 60 years old (OR=4.689, 95%CI=1.420 to 15.470, P=0.011), history of epilepsy (OR=3.007, 95%CI=1.270 to 7.118, P=0.012), NHISS score > 15 points at discharge (OR=2.699, 95%CI=1.257 to 5.797, P=0.011), and the hemorrhage site were risk factors of cognitive dysfunction after primary cerebral hemorrhage. Primary school education level or below (OR=0.382, 95%CI=0.159 to 0.913, P=0.030), the site of hemorrhage being the parieto-occipital lobe (OR=0.105, 95%CI=0.019 to 0.579, P=0.010) was a protective factor for patients with primary cerebral hemorrhage with concomitant cognitive deficits. The results of the model validation showed that,the C-index of the nomogram model was 0.785, the calibration curve is relatively consistent with the trend of the ideal curve, showed that the prediction model had good accuracy and consistency. Conclusions Patients with primary cerebral hemorrhage who are older, with lower educational level, higher discharged NHISS score, epilepsy history and hemorrhage in brain stem, basal ganglia thalamus region and frontotemporal region are prone to post-stroke cognitive dysfunction. The nomogram model constructed based on the above variables has high prediction efficiency.
作者
刘兴东
王希
颜伟
Liu Xingdong;Wang Xi;Yan Wei(Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210000,China)
出处
《神经疾病与精神卫生》
2023年第8期538-543,共6页
Journal of Neuroscience and Mental Health
基金
江苏省自然科学基金(BK20221418)。
关键词
卒中
原发性脑出血
卒中后认知功能障碍
影响因素
列线图
Stroke
Primary cerebral hemorrhage
Post-stroke cognitive dysfunction
Influencing factors
Nomogram model
