基于随机森林算法的COPD病人功能障碍的影响因素

Influencing factors of dysfunction in patients with COPD based on random forest algorithm

目的:探讨慢性阻塞性肺疾病(COPD)病人的功能障碍现状及其影响因素,为COPD的防控提供参考依据。方法:选取2020年6月—2021年3月天津市3所三级甲等医院的214例COPD病人,采用一般资料调查表、改良版呼吸困难问卷(mMRC)、COPD疾病评定量表(CAT)以及简明版ICF-COPD核心集进行问卷调查,通过随机森林算法对影响因素进行重要性排序,筛选出重要影响因素,应用Logistic回归模型探索其影响因素。结果:COPD病人功能障碍总得分为(15.13±8.36)分。随机森林算法选取的6个影响因素为CAT得分、近1年有无急性加重、个人消费用的用品或物质、气候、慢性阻塞性肺疾病全球倡议(GOLD)分级以及有无合并症。将这6个变量纳入Logistic回归分析,结果显示CAT评分(OR=11.091)、个人消费用的用品或物质(OR=5.136)、有无合并症(OR=2.480)、近1年急性加重(OR=2.347)是COPD病人功能障碍的影响因素。结论:疾病症状严重、药物获取或有效利用存在障碍、具有合并症、近1年有急性加重史和GOLD分级较高对COPD病人功能障碍影响较大。临床护理人员应重视COPD病人的功能障碍,有针对性地进行早期识别与干预。

Objective:To explore the current status of functional impairment and its influencing factors in patients with COPD,and to provide a reference basis for the prevention and control of COPD.Methods:A total of 214 patients with COPD in three tertiary care hospitals in Tianjin from June 2020 to March 2021 were selected and questionnaires were administered using a general information questionnaire,the modified version of the dyspnoea questionnaire(mMRC),the COPD assessment scale(CAT)and the brief version of the ICF‐COPD core set.And the importance of influencing factors was assessed by the random forest algorithm.The significant influencing factors were ranked,screened for multiple covariance,and logistic regression models were applied to explore their influencing factors.Results:COPD patients had a total functional impairment score of(15.13±8.36)and the random forest algorithm showed that the maximum number of features to generate the best forest was six.The top six influencing factors for analysis were CAT score,presence of acute exacerbations in the last year,personal substance use,environment,GOLD classification and presence of comorbidities.The random forest algorithm was used to screen the variables for Logistic regression,and the results showed that the COPD assessment test(OR=11.091),e110"supplies or substances for personal consumption"(OR=5.136),presence of comorbidities(OR=2.480),presence of acute exacerbations in the last year(OR=2.347)were influential factors for functional impairment in COPD patients.Conclusion:More severe disease symptoms,impaired access to or effective use of medication,having comorbidities,a history of acute exacerbations in the last year and a higher GOLD classification were the five factors that had a greater impact on functional impairment in patients with COPD.Clinical caregivers should pay attention to the functional impairment of patients with COPD and target early identification and intervention.