老年2型糖尿病合并高血压患者发生认知衰弱的影响因素及其风险预测列线图模型构建

Influencing Factors of Cognitive Decline in Elderly Patients with Type 2 Diabetes Mellitus and Hypertension and Construction of Nomogram Model for Predicting Its Risk

目的探讨老年2型糖尿病(T2DM)合并高血压患者发生认知衰弱的影响因素,构建其风险预测列线图模型并进行验证。方法选取2020—2023年在南京医科大学附属苏州医院就诊的老年T2DM合并高血压患者为调查对象,分别采用自制的一般资料调查表、微型营养评定简表(MNA-SF)、简化版老年抑郁量表15(GDS-15)、Barthel指数、中文版Morse跌倒评估量表(MFS)、中文版蒙特利尔认知评估量表(MoCA)调查患者一般资料、营养不良风险、抑郁情况、日常生活活动能力、跌倒风险、认知衰弱情况,共发放问卷227份,回收问卷220份,其中有效问卷215份,有效回收率为94.71%。采用多因素Logistic回归分析探讨老年T2DM合并高血压患者发生认知衰弱的影响因素;采用R 4.2软件及rms程序包构建列线图模型;采用Bootstrap法重复抽样1000次,计算一致性指数,进行Hosmer-Lemeshow拟合优度检验,绘制校准曲线、ROC曲线、决策曲线。结果215例老年T2DM合并高血压患者中,发生认知衰弱66例(30.70%),将其纳入发生组,将其余患者纳入未发生组。两组年龄、脑力活动情况、简化版GDS-15评分、Barthel指数、中文版MFS评分比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,年龄、脑力活动情况、简化版GDS-15评分、Barthel指数、中文版MFS评分是老年T2DM合并高血压患者发生认知衰弱影响因素(P<0.05)。基于影响因素构建列线图模型,该列线图模型的一致性指数为0.713〔95%CI(0.685~0.741)〕;Hosmer-Lemeshow拟合优度检验结果显示,该列线图模型拟合程度较好(P<0.05)。ROC曲线分析结果显示,该列线图模型预测老年T2DM合并高血压患者发生认知衰弱的AUC为0.924〔95%CI(0.884~0.963)〕。决策曲线分析结果显示,阈值概率为0.02~0.95时,该列线图模型预测老年T2DM合并高血压患者发生认知衰弱的净获益率>0。结论年龄、脑力活动情况、简化版GDS-15评分、Barthel指数、中文版MFS评分是老年T2DM合并高血压患者发生认知衰弱的影响因素,基于上述因素构建的风险预测列线图模型对老年T2DM合并高血压患者发生认知衰弱具有较好的预测价值及良好的临床净获益。

Objective To investigate the influencing factors of cognitive decline in elderly patients with type 2 diabetes mellitus(T2DM)and hypertension,and construct and verify its risk prediction nomogram model.Methods The elderly patients with T2DM combined with hypertension who were treated in the Affiliated Suzhou Hospital of Nanjing Medical University from 2020 to 2023 were selected as the research subjects.Self made General Information Survey Form,Mini Nutritional Assessment-Short Form(MNA-SF),simplified Geriatric Depression Scale-15(GDS-15),Barthel index,Chinese version of Morse Fall Scale(MFS),and Chinese version of Montreal Cognitive Assessment(MoCA)were used to investigate the patients'general information,malnutrition risk,depression status,daily living activity ability,fall risk,and cognitive decline status.A total of 227 questionnaires were distributed,220 questionnaires were collected,and 215 valid questionnaires were collected,with an effective response rate of 94.71%.Multivariate Logistic regression analysis was used to explore the influencing factors of cognitive decline in elderly patients with T2DM and hypertension.The nomogram model was constructed by using the R 4.2 software package and rms package.Bootstrap method was used to repeatedly sample 1000 times to perform internal validation of the nomogram model,and its consistency index was calculated.Hosmer-Lemeshow goodness of fit test was performed,calibration curve,ROC curve and decision curve were drawn.Results Among 215 elderly patients with T2DM combined with hypertension,66(30.70%)had cognitive decline and were included in the occurrence group,while the remaining patients were included in the non-occurrence group.There were significant differences in age,mental activity,simplified GDS-15 score,Barthel index and Chinese version of MFS score between the two groups(P<0.05).Multivariate Logistic regression analysis showed that age,mental activity,simplified GDS-15 score,Barthel index and Chinese version of MFS score were the independent influencing factors for cognitive decline in elderly patients with T2DM and hypertension(P<0.05).The nomogram model was constructed according to these influencing factors,the consistency index of the nomogram model was 0.713[95%CI(0.685-0.741)].The Hosmer-Lemeshow goodness of fit test showed that the nomogram model fitted well(P<0.05).The ROC curve analysis showed that the AUC of the nomogram model for predicting cognitive decline in elderly patients with T2DM and hypertension was 0.924[95%CI(0.884-0.963)].The result of decision curve analysis showed that when the threshold probability was 0.02-0.95,the net benefit rate of the nomogram model for predicting cognitive decline in elderly patients with T2DM and hypertension was>0.Conclusion Age,mental activity,simplified GDS-15 score,Barthel index and Chinese version of MFS score are the independent influencing factors for cognitive decline in elderly patients with T2DM and hypertension.The nomogram model constructed based on the above factors has good predictive value and good clinical net benefit for predicting cognitive decline in elderly patients with T2DM and hypertension.