摘要
目的探讨轻中度创伤性脑损伤(TBI)患者遗留认知障碍的影响因素并构建列线图预测模型。方法回顾性分析301例轻中度TBI患者的临床资料,使用蒙特利尔认知评估量表(MoCA)评估患者认知功能并根据是否遗留认知障碍分为两组,使用Logistic回归分析确定遗留认知障碍的独立影响因素。利用R软件对筛选出的独立影响因素建立列线图风险预测模型,使用一致性系数(C-index)和校准曲线评估模型的预测效能和符合度。结果301例轻中度TBI患者中,122例遗留认知障碍,发生率40.5%。多因素分析显示,高龄、GCS评分低、合并高血脂、颞叶有挫伤灶、存在蛛网膜下腔出血和入住ICU病房是轻中度TBI患者遗留认知障碍的独立危险因素(均P<0.05),受教育年限>12年及住院期间接受超早期康复治疗是轻中度TBI患者遗留认知障碍的独立保护因素(均P<0.05);基于上述8项影响因素建立的预测轻中度TBI患者遗留认知障碍的列线图模型预测性能高,C-index为0.845。结论轻中度TBI患者可通过基于年龄、GCS评分、是否合并高血脂、颞叶是否有挫裂伤、是否存在蛛网膜下腔出血、是否入住ICU病房、受教育年限及是否接受超早期康复治疗的列线图模型预测遗留认知障碍的风险,指导个体化评估与干预,改善患者预后。
Objective To explore the influencing factors of cognitive dysfunction in patients with mild to moderate traumatic brain injury(TBI)and to establish a prognostic nomogram model.Methods A retrospective study was performed on 301 patients with mild to moderate TBI.Patients were divided into two groups according to whether the patients had cognitive dysfunction evaluated by the Montreal Cognitive Assessment Scale(MoCA).Independent influencing factors affecting long-term cognitive deficits in mild to moderate TBI patients were analyzed by Logistic regression analysis.A nomogram model for predicting the risk of cognitive deficits was established by using R software,and the predictive performance and compliance of the model were evaluated by using the consistency index(C-index)and the calibration curve.Results Among 301 patients with mild to moderate TBI,122 patients had long-term cognitive dysfunction,with an incidence rate of 40.5%.Multivariate analysis showed advanced age,lower GCS score,hyperlipidemia,contusion of the temporal lobe,subarachnoid hemorrhage,ICU admission were independent risk factors for cognitive dysfunction in mild to moderate TBI patients(allP<0.05).More than 12 years of education and very early rehabilitation were independent protective factors for cognitive dysfunction in mild to moderate TBI patients(allP<0.05).The nomogram model established based on the above 8 influencing factors had good predictive performance,and the nomogram model had a high predictive accuracy with a C-index of 0.845.Conclusions The probability of cognitive dysfunction in patients with mild to moderate TBI should be predicted through the nomogram model according to age,GCS score,hyperlipidemia,contusion of the temporal lobe,subarachnoid hemorrhage,ICU admission,education level and very early rehabilitation.The nomogram model could be used to guide assessment and intervention for improving prognosis of the patients.
作者
孙毅
颜伟
刘兴东
沈之焱
王希
SUN Yi;YAN Wei;LIU Xingdong(Department of Neurosurgery,the First Affiliated Hospital of Nanjing Medical University,Nanjing 210029,China)
出处
《临床神经病学杂志》
CAS
2023年第6期425-429,共5页
Journal of Clinical Neurology
基金
江苏省六大人才高峰(WSW-006)。
关键词
轻中度创伤性脑损伤
认知障碍
影响因素
列线图
mild to moderate traumatic brain injury
cognitive dysfunction
influencing factor
nomogram
