创伤性脊髓损伤病人急性应激障碍危险因素分析及预测模型的构建

Analysis of risk factors for acute stress disorder in patients with traumatic spinal cord injury and construction of predictive model

目的:探讨创伤性脊髓损伤病人心理困扰及急性应激障碍发生现状及特征,筛选创伤性脊髓损伤病人发生急性应激障碍的相关影响因素,构建风险预测模型。方法:回顾性分析2020年1月—2021年5月在某三级甲等医院收治的241例创伤性脊髓损伤病人的临床资料、根据病人是否发生急性应激障碍(ASD)将病人分为ASD组(n=84)与非ASD组(n=157)。收集病人的一般人口学资料、疾病相关资料及斯坦福急性应激反应问卷(SASRQ)、心理弹性问卷(CD⁃RISC)、社会支持量表问卷(SSRS)测评结果。将单因素分析中差异有统计学意义的变量纳入Logistic回归模型,分析其危险因素并建立预测模型。结果:241例创伤性脊髓损伤病人中有84例发生ASD,发生率为34.9%;单因素分析结果显示,不同性别、年龄、婚姻状况、受伤时间、家庭收入、损伤分级和并发症病人ASD发生情况比较差异有统计学意义(P<0.001)。Logistic回归分析显示,女性、未婚或离异、并发症是创伤性脊髓损伤病人发生ASD的危险因素;年龄、损伤分级、坚韧维度及社会支持总分是病人ASD的保护性因素,构建风险预测模型受试者工作特征曲线下的面积(AUC)为0.850,95%CI[0.807,0.899],预测效果较好,准确度为80.08%,灵敏度为89.29%,特异度为69.43%,截断值为0.587。结论:女性、未婚或离异、伴有并发症是创伤性脊髓损伤病人发生ASD的危险因素,基于发现的危险因素建立的预测模型可用于创伤性脊髓损伤病人有无明显ASD的风险评估。

Objective:To investigate the status quo and characteristics of psychological distress and acute stress disorder(ASD)in patients with traumatic spinal cord injury,screen the relevant influencing factors of ASD in patients with traumatic spinal cord injury,and construct a risk prediction model.Methods:The clinical data of 241 patients with traumatic spinal cord injury admitted to a tertiary grade A hospital from January 2020 to May 2021 were retrospectively analyzed,and the patients were divided into ASD groups(n=84)and the non⁃ASD group(n=157).The general demographic data,disease⁃related data,and results of the Stanford Acute Stress Reaction Questionnaire(SASRQ),Connor⁃Davidson resilience scale(CD⁃RISC),and Social Support Rating Scale(SSRS)were collected.The variables with statistically significant differences in univariate analysis were incorporated into the logistic regression model to analyze its risk factors and establish a predictive model.Results:Among 241 patients with traumatic spinal cord injury,84 had ASD,with an incidence rate of 34.9%.Univariate analysis showed that the incidence of ASD in patients with different gender,ages,marital status,injury time,family income,injury level,and complications had statistically significant differences(P<0.001).Logistic regression analysis showed that female,unmarried or divorced,and complications were risk factors for ASD in patients with traumatic spinal cord injury;age,injury level,toughness dimension and total social support score were the protective factors.The area under the receiver operating characteristic curve(AUC)of the risk prediction model was 0.850,95%CI(0.807,0.899),the prediction effect was good,the accuracy was 80.08%,the sensitivity was 89.29%,the specificity was 69.43%,and the cut⁃off value was 0.587.Conclusions:Female,unmarried or divorced,and complications were risk factors for ASD in patients with traumatic spinal cord injury.The conducted prediction model based on the risk factors found in this study could be used to assess ASD in patients with traumatic spinal cord injury.