摘要
目的探讨老年慢性阻塞性肺疾病患者合并焦虑抑郁的影响因素,构建其风险预测列线图模型,并进行内部验证及外部验证。方法选取2022年5月—2025年1月淮安市第二人民医院接诊的老年慢性阻塞性肺疾病患者251例,采用随机数字表法按照7∶3比例将其分为建模集(n=176)和验证集(n=75)。采用自制《老年慢性阻塞性肺疾病患者焦虑抑郁的可能因素筛查问卷》及医院焦虑抑郁量表对患者进行调查。将建模集合并焦虑抑郁者纳入焦虑抑郁组,否则纳入对照组。采用多因素Logistic回归分析探讨老年慢性阻塞性肺疾病患者合并焦虑抑郁的影响因素;采用rms程序包构建老年慢性阻塞性肺疾病患者合并焦虑抑郁的风险预测列线图模型,并进行Hosmer-Lemeshow拟合优度检验、绘制ROC曲线。结果建模集176例老年慢性阻塞性肺疾病患者中,71例(40.34%)合并焦虑抑郁,其中39例合并焦虑、56例合并抑郁、24例合并焦虑和抑郁。对照组与焦虑抑郁组家庭人均月收入、过去6个月内急性加重者占比、病情严重程度、布里斯托慢性阻塞性肺疾病认知问卷(BCKQ)评分、社会支持度比较,差异有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,家庭人均月收入<3000元[OR=2.275,95%CI(1.091~4.745)]、过去6个月内急性加重[OR=2.558,95%CI(1.235~5.300)]、病情严重程度为中重度[OR=3.291,95%CI(1.687~6.421)]、社会支持度差[OR=2.695,95%CI(1.244~5.839)]为老年慢性阻塞性肺疾病患者合并焦虑抑郁的独立危险因素,而BCKQ评分升高[OR=0.766,95%CI(0.695~0.844)]为其独立保护因素(P<0.05)。基于家庭人均月收入、过去6个月内急性加重、病情严重程度、BCKQ评分、社会支持度构建老年慢性阻塞性肺疾病患者合并焦虑抑郁的风险预测列线图模型。内部验证:在建模集中,该列线图模型拟合程度较好(P>0.05),该列线图模型预测老年慢性阻塞性肺疾病患者合并焦虑抑郁的AUC为0.805[95%CI(0.737~0.873)]。外部验证:在验证集中,该列线图模型拟合程度较好(P>0.05),该列线图模型预测老年慢性阻塞性肺疾病患者合并焦虑抑郁的AUC为0.838[95%CI(0.776~0.901)]。结论家庭人均月收入<3000元、过去6个月内急性加重、病情严重程度为中重度、社会支持度差为老年慢性阻塞性肺疾病患者合并焦虑抑郁的独立危险因素,而BCKQ评分升高为其独立保护因素,基于上述因素构建的老年慢性阻塞性肺疾病患者合并焦虑抑郁的风险预测列线图模型具有较好的校准度、区分能力。
Objective To investigate the influencing factors of anxiety and depression in elderly patients with chronic obstructive pulmonary disease(COPD),construct its risk prediction nomogram model,and conduct internal and external validation.Methods A total of 251 elderly COPD patients admitted to Huai'an Second People's Hospital from May 2022 to January 2025 were selected and divided into modeling set(n=176)and validation set(n=75)in a ratio of 7∶3 by the random number table method.The patients were investigated by using the self-made"Screening Questionnaire for Possible Factors of Anxiety and Depression in Elderly COPD Patients"and the Hospital Anxiety and Depression Scale.The patients in modeling set with anxiety and depression were assigned to anxiety and depression group,otherwise assigned to control group.Multivariate Logistic regression analysis method was used to analyze the influencing factors of anxiety and depression in elderly patients with COPD.The nomogram model for predicting the risk of anxiety and depression in elderly patients with COPD was constructed by using the rms package.Hosmer-Lemeshow goodness of fit test was conducted and ROC curve was ploted.Results Among the 176 elderly COPD patients in the modeling set,71(40.34%)had anxiety and depression,including 39 had anxiety,56 had depression,and 24 had anxiety and depression.There were significant differences in average income per person in family,proportion of people with acute exacerbation in the past 6 months,severity of disease,Bristol COPD Knowledge Questionnaire(BCKQ)score,and social support between control group and anxiety and depression group(P<0.05).Multivariate Logistic regression analysis showed that average income per person in family<3000 yuan[OR=2.275,95%CI(1.091-4.745)],acute exacerbation in the past 6 months[OR=2.558,95%CI(1.235-5.300)],moderate to severe severity of disease[OR=3.291,95%CI(1.687-6.421)],poor social support[OR=2.695,95%CI(1.244-5.839)]were independent risk factors of anxiety and depression in elderly patients with COPD,BCKQ score increased[OR=0.766,95%CI(0.695-0.844)]was the independent protective factor(P<0.05).The nomogram model for anxiety and depression in elderly patients with COPD was constructed according to average income per person in family,acute exacerbation in the past 6 months,severity of disease,BCKQ score,and social support.Internal validation:the nomogram model fits well in modeling set(P>0.05),the AUC of the nomogram model for anxiety and depression in elderly patients with COPD was 0.805[95%CI(0.737-0.873)].External validation:the nomogram model fits well in validation set(P>0.05),the AUC of the nomogram model for anxiety and depression in elderly patients with COPD was 0.838[95%CI(0.776-0.901)].Conclusion Average income per person in family<3000 yuan,acute exacerbation in the past 6 months,moderate to severe severity of disease,poor social support are independent risk factors of anxiety and depression in elderly patients with COPD,BCKQ score increased is inpendent protective factor.The risk prediction nomogram model constructed based on the above factors has good calibration and discrimination ability.
作者
刘玉芳
陈彤
丁宗励
李娟
杨素花
LIU Yufang;CHEN Tong;DING Zongli;LI Juan;YANG Suhua(Department of Geriatrics,Huai'an Second People's Hospital,Huai'an 223001,China;Department of Neurology,Suqian First Hospital,Suqian 223800,China)
出处
《实用心脑肺血管病杂志》
2025年第8期34-39,46,共7页
Practical Journal of Cardiac Cerebral Pneumal and Vascular Disease
基金
江苏省老年健康科研课题项目(LK2021050)
江苏省老年医学临床技术应用研究项目带头人(LR2021028)
江苏省老年医学临床技术应用研究项目建设单位(LD2021036)。
关键词
肺疾病
慢性阻塞性
焦虑
抑郁
影响因素分析
列线图
Pulmonary disease,chronic obstructive
Anxiety
Depression
Root factors analysis
Nomograms
