腔隙性脑梗死后抑郁风险预测模型的构建

Prediction model construction of depression in patients with lacunar cerebral infarction

目的本研究探讨腔隙性脑梗死患者出院3月后发生抑郁的危险因素,构建风险预测模型。方法回顾性分析2021年1月1日至2022年1月1日在皖南医学院第二附属医院诊治的237例腔隙性脑梗死患者临床资料,收集入院时人口学数据、实验室指标和心血管疾病危险因素,使用患者健康问卷(patient health questionnaire-9,PHQ-9)评分评估出院3月后患者的脑卒中后抑郁(post strokedepression,PSD)风险,采用单因素和多因素Logistic回归分析确定抑郁风险的独立危险因素,基于上述危险因素构建预测模型,采用受试者工.作特征(receiver operating characteristic,ROC)曲线评估预测效能,采用校准曲线及决策曲线衡量预测模型的临床适用性。结果54例腔隙性脑梗死患者(22.80%)在出院3月后出现抑郁症状,多因素Logistic回归显示,女性(OR=2.952,95%CI:1.403~6.213,P=0.004)、胱抑素C(OR=2.964,95%CI:1.222~7.191,P=0.016)、载脂蛋白B(OR=4.836,95%CI:1.533~15.258,P=0.007)是腔隙性脑梗死患者出院3月后出现PSD的独立危险因素,日常生活能力(activityof dailyliving,ADL)评分(OR=0.939,95%CI:0.915~0.964,P<0.001)是腔隙性脑梗死患者PSD的保护性因素。预测模型曲线下面积(area underthe curve,AUC)为0.779(95%CI:0.703~0.855,P<0.001),优于其他预测因素。Hosmer-LemeshowH检验显示模型校准良好(P=0.588),此外,决策曲线分析预测模型具有良好的临床适用性。结论基于性别、实验室指标及日程生活能力评分构建的预测模型可用于评估腔隙性脑梗死患者出院3月后PSD风险,具有良好的预测效能和临床适用性,值得临床推广应用。

Objective To investigate the risk factors of depression in patients with lacunar cerebral infarction 3 months after discharge,and build a risk prediction model.Methods The clinical data of 237 patients with lacunar cerebral infarction diagnosed and treated in the Second Affiliated Hospital of Wannan Medical College from January 1,2021 to January 1,2022 were retrospectively analyzed.Demographic data,laboratory indicators and risk factors of cardiovascular disease were collected when the patients were admitted to hospital.The patient health questionnaire-9(PHQ-9)score was used to assess the risk of post-stroke depression(PSD)3 months after discharge.Univariate and multivariate logistic regression analyses were used to identify independent risk factors of depression.A predictive model was constructed based on the above risk factors.The predictive efficacy was evaluated by receiver operating characteristic(ROC)curve,and the clinical applicability of the predictive model was measured by calibration curve and decision curve.Results Fifty-four patients with lacunar infarction(22.80%)showed symptoms of depression at 3 months after discharge.Multivariate logistic regression showed that women(OR=2.952,95%CI:1.403-6.213,P=0.004),cystatin C(OR=2.964,95%CI:1.222-7.191,P=0.016),apolipoprotein B(OR=4.836,95%CI:1.533-15.258,P=0.007)were the independent risk factors for PSD in patients with lacunar infarction.Activity of daily living(ADL)score(OR=0.939,95%CI:0.915-0.964,P<0.001)was a protective factor for PSD in patients with lacunar infarction.The area under the curve(AUC)of the prediction model was 0.779(95%CI:0.703-0.855,P<0.001),which was better than other predictors.Hosmer-Lemeshow H test showed that the model was well calibrated(P=0.588).In addition,the prediction model of decision curve analysis had a good clinical applicability.Conclusions The predictive model based on gender,laboratory indicators and daily life ability score can evaluate the risk of PSD in patients with lacunar infarction 3 months after discharge.It is good predictive efficacy and clinical applicability which worth clinical promotion and application.