多发腔隙性脑梗死患者发生认知障碍的危险因素分析与预测模型构建-现代医学

多发腔隙性脑梗死患者发生认知障碍的危险因素分析与预测模型构建

单位：南京市中心医院老年病学科, 江苏南京 210000

分类号：R473.5

出版年·卷·期（页码）：2025·53·第二期（172-178）

摘要：

目的：探讨多发腔隙性脑梗死患者发生认知障碍的危险因素并构建预测模型。方法：回顾性分析2022年1月—2024年1月于南京市中心医院住院治疗的252例多发腔隙性脑梗死老年患者的临床资料，根据是否出现认知障碍分为认知障碍组(n=198)和非认知障碍组(n=54)。比较两组临床风险因素，明确老年多发腔隙性脑梗死患者发生认知障碍的风险因素，根据结果构建预测模型，绘制受试者工作特征曲线分析模型的预测价值。结果：本研究纳入252例多发腔隙性脑梗死老年患者，认知障碍发生率为78.57%(198/252)。多因素Logistic回归分析显示饮酒(OR=1.211，95%CI：1.174～5.968)、高血压(OR=1.906，95%CI：1.174～5.968)、高同型半胱氨酸血症病史(OR=2.035，95%CI：1.244～7.416)、运动时间<15 h·周^-1(OR=1.865，95%CI：1.207～7.144)、家族痴呆史(OR=2.977，95%CI：1.286～9.718)、美国国立卫生研究院卒中量表评分＞10分(OR=3.255，95%CI：1.308～11.897)、额叶梗死(OR=2.474，95%CI：1.237～8.498)、脑桥梗死(OR=2.195，95%CI：1.244～9.007)以及基底核梗死(OR=2.103，95%CI：1.239～8.012)是多发腔隙性脑梗死老年患者中发生认知障碍危险因素。根据风险因素构建预测模型，该模型ROC曲线下面积为0.813(95%CI：0.728～0.898)，灵敏度和特异度分别为0.77和0.76。结论：本研究表明，饮酒、高血压、HHcy病史、运动时间、家族痴呆史、NIHSS评分、额叶梗死、脑桥梗死及基底核梗死与老年多发腔隙性脑梗死患者发生认知障碍密切相关。基于上述危险因素构建的预测模型具有较好的预测性能，可为临床早期筛查和护理干预提供有力支持，具有重要的临床应用价值。

Objective: To investigate the risk factors for cognitive impairment in patients with multiple lacunar infarctions and to construct a predictive model. Methods: A retrospective analysis was conducted on the clinical data of 252 elderly patients with multiple lacunar cerebral infarctions who were hospitalized in Nanjing Central Hospital from January 2022 to January 2024. Based on the presence of cognitive impairment, the patients were divided into a cognitive impairment group(n=198) and a non-cognitive impairment group(n=54). The clinical risk factors of the two groups were compared to identify the risk factors for cognitive impairment in elderly patients with multiple lacunar cerebral infarctions. A predictive model was then constructed based on the results, and the ROC curve was plotted to analyze the predictive value of the model. Results: This study included 252 elderly patients with multiple lacunar cerebral infarctions, with a cognitive impairment incidence rate of 78.57%(198/252). Multivariate Logistic regression analysis showed that alcohol consumption(OR=1.211,95%CI:1.174-5.968), hypertension(OR=1.906,95%CI:1.174-5.968), history of HHcy(OR=2.035,95%CI:1.244-7.416), exercise time<15 h·week^-1(OR=1.865,95%CI:1.207-7.144), family dementia history(OR=2.977,95%CI:1.286-9.718), National Institute of Health Stroke Scale score>10 points(OR=3.255,95%CI:1.308-11.897), frontal lobe infarction(OR=2.474,95%CI:1.237-8.498), pontine infarction(OR=2.195,95%CI:1.244-9.007), and basal ganglia infarction(OR=2.103,95%CI:1.239-8.012) were risk factors for cognitive impairment in elderly patients with multiple lacunar infarcts, based on which a predictive model was constructed, with an area under the receiver operating characteristic curve of 0.813(95%CI:0.728-0.898), and a sensitivity and specificity of 0.77 and 0.76, respectively. Conclusion: This study indicates that alcohol consumption, hypertension, hyperhomocysteinemia history, physical activity, family history of dementia, NIHSS score, frontal lobe infarction, pontine infarction, and basal ganglia infarction are closely associated with the occurrence of cognitive impairment in elderly patients with multiple lacunar cerebral infarctions. Prediction models based on these risk factors have good predictive performance and can provide strong support for early clinical screening and nursing intervention, which has important clinical application value.

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