中型颅脑损伤后认知障碍的影响因素分析

Analysis of influencing factors of cognitive impairment after moderate traumatic brain injury

目的探讨中型颅脑损伤后认知障碍的影响因素并建立中型颅脑损伤后认知障碍发生的预测模型。方法回顾性分析2016年11月至2018年2月中南大学湘雅三医院神经外科收治的104例中型颅脑损伤患者的临床资料。应用蒙特利尔认知评估量表(MoCA)评估颅脑损伤患者伤后3个月的认知功能。采用单因素分析和多因素logistic回归分析探讨中型颅脑损伤后认知障碍的影响因素。建立中型颅脑损伤后认知障碍的预测模型并评估其性能。结果多因素logistic回归分析结果显示,年龄(OR=1.118,95%CI:1.000~1.250,P=0.049)、受教育程度(OR=0.202,95%CI:0.041~0.988,P=0.045)、入院时格拉斯哥昏迷评分(GCS)(OR=2.582,95%CI:1.242~5.369,P=0.011)以及受伤原因(OR=0.429,95%CI:0.201~0.915,P=0.029)为中型颅脑损伤后认知障碍发生的独立影响因素。基于年龄、受教育程度、入院时GCS评分以及受伤原因建立的中型颅脑损伤后认知障碍预测模型的性能良好(偏卡方检验P>0.05,受试者工作特征曲线的曲线下面积为0.902),其验证样本预测中型颅脑损伤后认知障碍的准确率为88.6%,灵敏度为55.6%,特异度为100.0%。结论年龄、受教育程度、入院时GCS评分以及受伤原因为中型颅脑损伤后认知障碍的危险因素。基于年龄、受教育程度、入院时GCS评分以及受伤原因所建立的预测模型可早期、准确地预测中型颅脑损伤后认知障碍的发生。

Objective To analyze the influencing factors of cognitive impairment after moderate traumatic brain injury and to develop prognostic models for cognitive impairment after moderate traumatic brain injury.Methods A prospective study was performed on 104 patients with moderate traumatic brain injury at Department of Neurosurgery,the Third Xiangya Hospital,Central South University from November 2016 to February 2018.The cognitive function at 3 months after injury was assessed using the Montreal cognitive assessment(MoCA)score.The impact of various lesions on cognitive function was analyzed using univariate and multivariate logistic regression.Prognostic models was established based on logistic regression analysis results.The validation sampling was used to compute the accuracy,sensitivity and specificity of the prognostic models.Results Logistic regression analysis revealed that age(OR=1.118,95%CI:1.000-1.250,P=0.049),education(OR=0.202,95%CI:0.041-0.988,P=0.045),Glasgow coma scale(GCS)score(OR=2.582,95%CI:1.242-5.369,P=0.011)and injury cause(OR=0.429,95%CI:0.201-0.915,P=0.029)were independent risk factors of cognitive impairment after moderate traumatic brain injury.The prognostic model based on the risk factors of admission had favorable performance(P>0.05 for partial chi square test,0.902 for area under curve).The accuracy of the prognostic model was 88.6%.The sensitivity and specificity were 55.6%and 100.0%respectively.Conclusions Age,education,GCS score and injury cause are influencing factors of cognitive impairment after moderate traumatic brain injury,based on which the established model could be used to timely and accurately predict the prognosis of cognitive impairment after moderate traumatic brain injury.