老年高血压患者认知功能障碍的预测模型构建-现代医学

老年高血压患者认知功能障碍的预测模型构建

单位：南京市中心医院门诊部, 江苏南京 210000

分类号：R473.5

出版年·卷·期（页码）：2025·53·第二期（179-186）

摘要：

目的：探讨老年高血压患者发生认知功能障碍的危险因素并构建预测模型。方法：回顾性分析2022年2月至2024年2月于南京市中心医院就诊的405例老年高血压患者的临床资料，根据是否出现认知障碍分为认知障碍组(n=156)和非认知障碍组(n=249)。比较两组临床风险因素，明确老年高血压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ROC曲线分析模型的预测价值。结果：本研究纳入405例老年高血压患者，认知障碍发生率为38.52%(156/405)。多因素Logistic回归分析显示独居(OR=1.614，95%CI：1.048～4.743)、饮酒(OR=2.314，95%CI：1.127～6.895)、糖尿病(OR=2.295，95%CI：1.149～6.281)、睡眠障碍(OR=2.894，95%CI：1.197～7.057)、高血压Ⅱ~Ⅲ级(OR=3.654，95%CI：1.211～10.315)、高血压病程≥5年(OR=4.021，95%CI：1.312～15.126)、服药依从性较差(OR=3.355，95%CI：1.203～9.972)、SSRS评分≤35分(OR=2.618，95%CI：1.178～6.907)、应激史(OR=2.604，95%CI：1.147～7.108)以及抑郁(OR=1.826，95%CI：1.107～5.825)是老年高血压患者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0.798(95%CI：0.710～0.886)，灵敏度和特异度分别为0.79和0.77。结论：本研究建立的模型纳入了独居、饮酒、糖尿病、睡眠障碍、高血压Ⅱ～Ⅲ级、高血压病程≥5年、服药依从性较差、低SSRS评分、应激史及抑郁等一系列老年高血压患者发生认知功能障碍的危险因素，为老年高血压患者认知障碍的早期识别和护理干预提供重要支持，具有一定临床应用价值。

Objective: To investigate the risk factors for cognitive impairment in elderly hypertensive patients and to construct a predictive model. Methods: A retrospective analysis was conducted on the clinical data of 405 elderly hypertensive patients who visited Nanjing Central Hospital between February 2022 and February 2024. The patients were divided into two groups based on the presence of cognitive impairment:the cognitive impairment group(n=156) and the non-cognitive impairment group(n=249). Clinical risk factors between the two groups were compared to identify the risk factors for cognitive impairment in elderly hypertensive patients. Based on the findings, a predictive model was constructed, and the predictive value of the model was analyzed using ROC curves. Results: This study included 405 elderly hypertensive patients, with a cognitive impairment incidence rate of 38.52%(156/405). Multivariate logistic regression analysis showed that living alone(OR=1.614, 95%CI:1.048-4.743), alcohol consumption(OR=2.314, 95%CI:1.127-6.895), diabetes(OR=2.295, 95%CI:1.149-6.281), sleep disorders(OR=2.894, 95%CI:1.197-7.057), hypertension stage Ⅱ-Ⅲ(OR=3.654, 95%CI:1.211-10.315), duration of hypertension ≥ 5 years(OR=4.021, 95%CI:1.312-15.126), poor medication adherence(OR=3.355, 95%CI:1.203-9.972), SSRS score ≤ 35(OR=2.618, 95%CI:1.178-6.907), history of stress(OR=2.604, 95%CI:1.147-7.108), and depression(OR=1.826, 95%CI:1.107-5.825) were risk factors for cognitive impairment in elderly hypertensive patients. Based on these risk factors, a predictive model was constructed, and the area under the ROC curve for the model was 0.798(95%CI:0.710-0.886), with a sensitivity and specificity of 0.79 and 0.77, respectively. Conclusion: The model established in this study includes a range of risk factors for cognitive impairment in elderly hypertensive patients, such as living alone, alcohol consumption, diabetes, sleep disorders, hypertension stageⅡ-Ⅲ, hypertension duration ≥ 5 years, poor medication adherence, low SSRS score, history of stress, and depression. This model provides important support for the early identification and nursing intervention of cognitive impairment in elderly hypertensive patients, holding certain clinical application value.

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