中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (04): 259-263.doi: 10.3969/j.issn.1671-4091.2023.04.003

• 临床研究 • 上一篇    下一篇

基于LASSO回归下维持性血液透析患者认知功能减退的预测模型构建分析

樊 伟    闻 萍    邵丽娜   崔 英   张 瑾   

  1. 214200 无锡，1江苏省无锡市宜兴市人民医院肾内科 210003 南京，2南京医科大学第二附属医院肾内科
  • 收稿日期:2022-09-08 修回日期:2023-01-17 出版日期:2023-04-12 发布日期:2023-04-12
  • 通讯作者: 张瑾 E-mail:2412992314@qq.com

Construction of predictive model for cognitive decline in maintenance hemodialysis patients based on LASSO regression

FAN Wei, WEN Ping, SHAO Li-na, CUI Ying, ZHANG Jin   

  1. 1Department of Nephrology, YixinPeoples Hospital of Jiangsu Province, Wuxi 214200, China; 2Department of Nephrology, The Second Affliliated Hospital of Nanjing Medical University, Nanjing 210003, China
  • Received:2022-09-08 Revised:2023-01-17 Online:2023-04-12 Published:2023-04-12
  • Contact: 214200 无锡，1江苏省无锡市宜兴市人民医院肾内科 E-mail:2412992314@qq.com

PDF

52

摘要： 目的：构建基于LASSO回归下维持性血液透析（maintenance hemodialysis，MHD）患者认知功能减退的预测模型。方法：前瞻性纳入2016年3月到2021年3月期间于我院接受MHD治疗的100例患者为研究对象。应用蒙特利尔认知评估量表（MontrealCognitiveAssessment, MoCA）评估所有患者的认知功能，根据MocA量表总得分是否低于26分，将患者分为认知功能障碍（Cognitive impairment, CI）（MocA量表<26分）组、非CI组（MocA量表≥26分）。收集所有患者的一般资料及临床资料，使用Lasso回归筛选具有非0系数的MHD患者发生CI相关特征因素，构建Lasso--Logistics回归模型，绘制受试者工作特征曲线（receiver operating characteristic curve，ROC），计算受试者工作特征曲线下面积 （Area Under Curve, AUC）、敏感度及特异度。结果：最终有62例患者MocA量表<26分，作为CI组，有38例患者MocA量表≥26分，为非CI 组。Lasso回归结果显示年龄、透析龄、合并糖尿病、hs-CRP、甘油三酯、总胆固醇、血清白蛋白、血清钙与MHD患者CI的发生具有显著相关性。Logistics回归进一步分析显示年龄（OR（95% C.I.）=1.135（1.041~1.238））、透析龄（OR（95% C.I.）=1.138（1.012~1.279））、hs-CRP（OR（95% C.I.）=14.434（1.545~134.893））、血清白蛋白（OR（95% C.I.）=0.759（0.593~0.971））是MHD患者发生CI的危险因素，所对应的非零系数分别为 0.01611309、 0.01801511、0.33247335、 -0.03645051。Lasso--Logistics回归模型预测MHD患者CI发生的AUC为0.892（95%CI：0.813~0.945），敏感性、特异性分别为75.81%、89.47%。结论：年龄、透析龄、hs-CRP、低白蛋白是影响MHD患者发生CI的危险因素，构建的预测模型可用于MHD人群的CI筛查。

关键词: LASSO回归, 维持性血液透析, 认知功能, 预测模型

Abstract: Objective  To construct a predictive model based on LASSO regression for maintenance hemodialysis (MHD) patients with cognitive decline.  Methods  100 patients treated with MHD in Yixing People's Hospital from March 2016 to March 2021 were prospectively included. The patients were classified into a cognitive impairment (CI) group (MocA＜26) and a non-CI group (MocA≥26) using the Montreal cognitive assessment (MocA) scale. General and clinical data were collected. Characteristic factors related to CI in MHD patients with non-zero coefficients were screened by LASSO regression. Lasso-Logistics regression model was constructed and receiver operating characteristic curve (ROC) was drawn to evaluate the model effectiveness. Data rows of 71 MHD patients were selected for external verification.  Results  There were 62 patients in CI group and 38 patients in non-CI group, respectively. LASSO regression showed that age, dialysis vintage, diabetes mellitus (OR=1.673, 95%CI:0.150～18.661,P=0.676), higher sensitive C-reactive protein(hs-CRP), triglyceride, total cholesterol, serum albumin and serum calcium were significantly correlated with the occurrence of CI in MHD patients. Logistic regression analysis showed that age (OR=1.135, 95%CI:1.041～1.238, P=0.004), dialysis vintage (OR=1.138, 95%CI :1.012～1.279, P=0.031), hs-CRP (OR=2.394, 95%CI:1.158～4.950, P=2.394), serum albumin (OR=0.759, 95%CI: 0.593～0.971,P=0.028) were risk factors for CI in MHD patients. Lasso-logistics regression model predicted that the AUC of CI occurrence in MHD patients was 0.892 (95%CI: 0.813～0.945). External verification showed that the area under the curve (AUC) was 0.899 (95%CI: 0.0.804～0.958), and the Youden index J was 0.713.   Conclusion  Age, dialysis vintage, hs-CRP and lower albumin were significantly correlated with the incidence of CI in MHD patients, and the established prediction model could better predict the incidence of CI in MHD patients. 

Key words: LASSO regression, Maintenance hemodialysis, Cognitive function, Predictive

中图分类号: