摘要
目的探究肝硬化患者并发睡眠障碍的影响因素,并基于此构建肝硬化患者并发睡眠障碍的预测模型及进行验证。方法选取2023年1—10月医院收治的肝硬化患者130例为研究对象,通过单因素分析及多因素Logistic回归分析得出肝硬化患者并发睡眠障碍的独立影响因素,并基于此使用RStudio软件构建对应的风险预测模型,通过患者工作特征(receiver operating characteristic,ROC)曲线和校准曲线评估肝硬化患者并发睡眠障碍预测模型的区分度和校准度。另选取2023年11月—2024年2月在医院就诊的肝硬化患者56例作为验证集,采用验证集数据绘制ROC、校准曲线及决策曲线对预测模型的预测效能进行验证。结果本研究共纳入130例肝硬化患者,其中有60例肝硬化患者PSQI得分≥7分,肝硬化患者睡眠障碍患病率为46.15%(60/130)。多因素Logistic回归分析结果显示,性别、家庭收入、家庭关系、HAMA评分及HAMD评分均是肝硬化患者并发睡眠障碍的独立影响因素(P<0.05)。以此构建的风险预测模型的ROC曲线下面积(area under curve,AUC)为0.833(95%CI=0.761~0.905),最大Youden指数为0.574,敏感度为0.717,特异度为0.857,对肝硬化患者并发睡眠障碍预测模型有较好的预测价值。校准曲线结果显示χ^(2)=10.367,P=0.240,预测模型的预测概率与实际发生概率之间差异不大,具有较好的临床实用性。临床决策曲线显示列线图的临床收益较好。结论性别、家庭收入、家庭关系、HAMA评分及HAMD评分均是肝硬化患者并发睡眠障碍的独立影响因素,其中男性、家庭收入高、家庭关系和睦、HAMA和MAMD评分低的肝硬化患者不易并发睡眠障碍。基于此构建的肝硬化患者并发睡眠障碍风险预测模型其预测效能良好,可以准确预测肝硬化患者并发睡眠障碍情况,可为医务人员对患者的管理提供策略支持。
Objective To investigate the influencing factors of sleep disorders in patients with liver cirrhosis,and to construct a prediction model and to validate.Methods 130 cases of cirrhotic patients admitted to hospital from January to October 2023 were selected as study subjects,and the independent influencing factors of cirrhotic patients with concurrent sleep disorders were identified by univariate analysis and multifactorial Logistic regression analysis,based on which the corresponding risk prediction model was constructed by using RStudio software,and the discrimination and calibration of the prediction model were evaluated by the ROC curve and calibration curve of the receiver operating characteristic(ROC).Based on this,the corresponding risk prediction model was constructed by using RStudio software,and the discrimination and calibration of the prediction model of sleep disorders in patients with cirrhosis were evaluated by the receiver operating characteristic(ROC)curve and calibration curve.In addition,56 cases of cirrhosis patients who attended the hospital from November 2023 to February 2024 were selected as the validation set,and the ROC,calibration curve and decision curve were plotted using the data from the validation set to validate the predictive efficacy of the prediction model.Results A total of 130 cirrhotic patients were included in this study,of which 60 cirrhotic patients had PSQI scores≥7.The prevalence of sleep disorders in cirrhotic patients was 46.15%(60/130).The results of multifactorial Logistic regression analysis showed that gender,family income,family relationship,HAMA score and HAMD score were all independent influences on the comorbidity of sleep disorders in patients with liver cirrhosis(P<0.05).The area under curve(AUC)of the risk prediction model had an area under curve(AUC)of 0.833(95%CI=0.761~0.905),a maximum Youden index of 0.574,a sensitivity of 0.717,and a specificity of 0.871,which provided good predictive value of the prediction model of concomitant sleep disorders in patients with liver cirrhosis.The results of the calibration curve showedχ^(2)=10.367,P=0.240,and the difference between the predicted probability of the prediction model and the actual probability of occurrence was not significant,which has good clinical utility.The clinical decision curve showed a better clinical benefit of the column-line diagram.Conclusion Gender,family income,family relationship,HAMA score and HAMD score were the independent influencing factors in which cirrhotic patients who are male,high family income,harmonious family relationship,and low HAMA and MAMD scores are less prone to the complication of sleep disorders.The risk prediction model of sleep disorder in cirrhotic patients constructed based on this model has good predictive efficacy and can accurately predict the complication of sleep disorder in cirrhotic patients,which can provide strategic support for the management of patients by medical personnel.
作者
徐蓓
帅水云
吴巧珍
何含芳
熊艳艳
祝三秀
张芝华
XU Bei;SHUAI Shuiyun;WU Qiaozhen;HE Hanfang;XIONG Yanyan;ZHU Sanxiu;ZHANG Zhihua(Yingtan People's Hospital,Yingtan 335000,China;The Fourth Affiliated Hospital of Nanchang University,Nanchang 330008,China)
出处
《护理实践与研究》
2025年第6期836-842,共7页
Nursing Practice and Research
基金
鹰潭市科技局科技计划项目(编号:YKZ2023009)。
关键词
肝硬化
睡眠障碍
预测模型
影响因素
家庭关系
心理状态
Cirrhosis
Sleep disorder
Prediction model
Influencing factors
Family relationship
Psychological state
