老年心血管疾病患者发生抑郁症的风险预测模型分析

Risk prediction model analysis of depression in elderly patients with cardiovascular disease

目的分析社区老年心血管疾病患者发生抑郁症的风险,为社区老年心血管疾病患者防治抑郁症的发生提供依据。方法选取2019年8月至2020年8月来重庆市涪陵中心医院治疗的社区老年心血管疾病患者486例,采用GES-D量表评定患者抑郁状态,根据GES-D评分分为抑郁组(GES-D评分≥16分,n=91)和对照组(GES-D评分<16分,n=395),收集患者年龄、性别、心血管疾病、婚姻状况等;采用logistic回归对可能影响老年心血管疾病发生抑郁症的因素进行分析。将统计的临床资料纳入多因素logistic回归分析,构建logistic回归模型,根据回归结果建立社区老年心血管疾病患者发生抑郁症的风险预测模型,采用ROC曲线对该模型效能进行预测。结果486例社区老年心血管疾病患者中,心血管疾病患者合并抑郁91例,不同老年心血管疾病间抑郁症状发生率间差异有统计学意义(P<0.05);冠心病合并抑郁症状发生率显著高于高血压、高脂血症、心律失常抑郁症状发生率(P<0.05);女性患者合并抑郁症状发病率高于男性(P<0.05);两组患者在性别、文化程度、饮酒史、吸烟史、睡眠情况、日常生活能力及心血管疾病种数间差异有统计学意义(P<0.05);女性、合并心血管疾病种数>3个、日常生活能力差、睡眠障碍是社区老年心血管疾病患者合并抑郁症状的独立危险因素(P<0.05);社区老年心血管疾病患者发生抑郁症的风险预测模型为P=[1+e^(-(-0.471+0.482)×(女性)+0.839×(合并心血管疾病种数>3个+0.839)×(睡眠障碍)+0.839×(日常生活能力差))];采用ROC曲线对该回归模型预测效能进行分析,结果表明社区老年心血管疾病患者风险预测模型预测抑郁症的AUC为0.739,95%CI(0.672~0.813)。结论社区老年心血管疾病患者合并抑郁症状的发生率较高,女性、合并心血管疾病种数>3个、日常生活能力差、睡眠障碍的社区老年心血管疾病患者发生抑郁的风险较大,应重视患者的抑郁症状,以便及早诊治。

Objective To analyze the risk of depression in elderly patients with cardiovascular disease in community,and to provide evidence for the prevention and treatment of depression in elderly patients with cardiovascular disease in community.Methods A total of 486 elderly community patients with cardiovascular disease who were treated in Fuling Central Hospital of Chongqing from August 2019 to August 2020 were selected.The depression status of the patients was assessed by GES-D scale.According to GES-D score,the patients were divided into depression group(GES-D score≥16 points,n=91)and control group(GES-D score<16 points,n=395).Age,gender,cardiovascular disease and marital status of patients were collected.Logistic regression was used to analyze the possible influencing factors of depression in elderly patients with cardiovascular disease.The statistical clinical data were included in the multivariate logistic regression analysis,and the logistic regression model was established.According to the regression results,the risk prediction model of depression in elderly patients with cardiovascular disease in community was established.The ROC curve was used to predict the effectiveness of the model.Results Among 486 elderly patients with cardiovascular disease in community,91 patients with cardiovascular disease were complicated with depression,and there was statistical significance in the incidence of depressive symptoms among different elderly patients with cardiovascular disease(P<0.05).The incidence of CHD with depressive symptoms was significantly higher than that of hypertension,hyperlipidemia and arrhythmia(P<0.05).The incidence of depressive symptoms in female patients was higher than that in male patients(P<0.05).There were statistically significant differences between the two groups in gender,education level,drinking history,smoking history,sleep status,daily living ability and number of cardiovascular diseases(P<0.05).Female,more than 3 kinds of cardiovascular disease,poor ability of daily living,and sleep disturbance were independent risk factors for depression in elderly community cardiovascular disease patients(P<0.05).The risk prediction model of depression in elderly patients with cardiovascular disease in community was P=[1+e^(-(-0.471+0.482)×(female)+0.839×(combined cardiovascular disease species>3)+0.839×(sleep disorders)+0.839×(daily life ability difference))];ROC curve was used to analyze the predictive performance of the regression model.The results showed that the AUC of the community elderly cardiovascular disease risk prediction model to predict depression was 0.739,95%CI(0.672-0.813).Conclusion The incidence of depressive symptoms in elderly community patients with cardiovascular disease is higher,and the risk of depression in elderly community patients with cardiovascular disease is higher in women,with more than 3 types of cardiovascular disease,poor daily living ability,and sleep disturbance.Therefore,attention should be paid to the depressive symptoms of patients,so as to facilitate early diagnosis and treatment.