阿尔茨海默病发生吸入性肺炎危险因素分析及预测模型构建

Analysis of risk factors and construction of predictive model for inhalation pneumonia in hospitalized patients with Alzheimer’s disease

目的 分析住院阿尔茨海默病患者发生吸入性肺炎的危险因素,建立列线图预测模型。方法 选取2019年10月~2023年1月浙江省丽水市第二人民医院治疗的452例住院阿尔茨海默病患者随机分为350例模型组和102例验证组,模型组患者依据是否发生吸入性肺炎分为82例吸入性肺炎组和268例无吸入性肺炎组,记录患者临床资料。采用多因素Logistic回归模型分析影响住院阿尔茨海默病患者吸入性肺炎的危险因素;采用受试者工作特征(ROC)曲线及校正曲线分析验证列线图模型的预测价值。结果 验证组与模型组年龄、性别、体质量指数(BMI)等临床资料比较,差异均无统计学意义(P>0.05)。吸入性肺炎组年龄>60岁、吞咽困难、住院时间>30天、鼻饲或胃肠道营养、胃食管反流、咳嗽反射减弱患者比例高于无吸入性肺炎组,差异有统计学意义(P<0.01)。年龄>60岁、吞咽困难、住院时间>30天、鼻饲或胃肠道营养、胃食管反流、咳嗽反射减弱是影响住院阿尔茨海默病患者吸入性肺炎的独立危险因素(P<0.01)。ROC曲线、校正曲线的内部验证及外部验证结果显示,列线图模型的预测价值、区分度、一致性较高。结论基于年龄、吞咽困难、住院时间、鼻饲或胃肠道营养、胃食管反流、咳嗽反射减弱构建的列线图模型对住院阿尔茨海默病患者吸入性肺炎有良好的预测效能,有助于临床决策。

Objective To analyze the risk factors of inhalation pneumonia in hospitalized patients with Alzheimer’s disease and establish a nomograph prediction model.Methods A total of 452 hospitalized patients with Alzheimer’s disease who were treated in Zhejiang the Second People’s Hospital of Lishui from October 2019 to January 2023 were randomly grouped into 350 cases in model group and 102 cases in validation group.Patients in the model group were grouped into 82 cases in aspiration pneumonia group and 268 cases in non aspiration pneumonia group based on whether they developed aspiration pneumonia,the clinical data of the patient were recorded.Multivariate Logistic regression model was applied to analyze the risk factors of inhalation pneumonia in hospitalized patients with Alzheimer’s disease;the predictive value of the nomogram model was validated using the receiver operating characteristic(ROC)curve and correction curve analysis.Results There were no obvious differences in clinical data such as age,gender,and body mass index(BMI)between the validation group and the model group(P>0.05).The proportions of patients with age>60 years old,dysphagia,hospital stay>30天ays,nasal feeding or gastrointestinal nutrition,gastroesophageal reflux,and decreased cough reflex in the inhalation pneumonia group were obviously higher than those in the non inhalation pneumonia group(P<0.01).Age>60 years old,dysphagia,hospi tal stay>30天ays,nasal feeding or gastrointestinal nutrition,gastroesophageal reflux,and decreased cough reflex were independent risk factors for inhalation pneumonia in hospitalized patients with Alzheimer’s disease(P<0.01).The internal and external validation results of ROC curves and calibration curves showed that the nomogram model had high predictive value,discrimination,and consistency.Conclusion The nomograph model based on age,dysphagia,length of stay,nasal feeding or gastrointestinal nutrition,gastroesophageal reflux,and decreased cough reflex has a good predictive effect on inhaled pneumonia in hospitalized patients with Alzheimer’s disease.