摘要
目的 探讨帕金森病(PD)患者冻结步态(FOG)的发生率和危险因素,开发一款实用性强的列线图模型指导临床实践。方法 回顾性总结2019年3月-2022年3月浙江省金华市中心医院确诊PD患者208例,根据临床症状分为FOG组98例和无FOG组110例。比较两组临床资料,多因素Logistic回归模型筛选危险因素并建立列线图模型。结果 (1)FOG组年龄和PD首发年龄、PD病程,帕金森病问卷(PDQ39)、汉密尔顿抑郁量表(HAMD-17)和焦虑量表(HAMA-14)、快速眼球运动睡眠行为障碍筛查问卷(RBDSQ)和匹兹堡睡眠质量指数(PSQI)评分均显著大于无FOG组,视空间功能障碍增多,吞咽、书写和翻身能力、改良Hoehn-Yahr(H-Y)分级严重程度显著高于无FOG组,而简易智能精神状态检查表(MMSE)评分降低(P<0.05)。多因素Logistic回归显示,RBDSQ评分(OR=2.856,95%CI:2.124-3.689,P<0.01)、PDQ39评分(OR=4.457,95%CI:3.659-5.231,P<0.01)、视空间功能障碍(OR=1.659,95%CI:1.232-2.325,P<0.01)和H-Y分级(OR=3.025,95%CI:2.565-3.869,P<0.01)是PD患者FOG发生的独立危险因素。R软件建立总分120分的列线图模型,受试者工作曲线(ROC曲线)计算列线图预测FOG的曲线下面积(AUC)为0.889(95%CI:0.832-0.956,P<0.01),提示模型的预测效能较好。Hosmer-Lemeshow检验显示,模型的拟合优度较好(χ^(2)=5.624,P=0.897)。校准曲线显示模型预测概率与实际发生率有较好的一致性。决策曲线显示模型的临床获益性较好。结论 PD患者FOG发生率较高,入院RBDSQ和PDQ39评分、视空间功能障碍和H-Y分级是患者主要FOG预测因子。此列线图模型指导临床早期辅助筛查FOG高危患者并进行诊断,具有较好的应用潜力。
Objective To investigate the incidence and risk factors of freezing of gait(FOG)in patients with Parkinson's disease(PD)and construct a nomogram model with practical use for guiding clinical practice.Methods A total of 208 patients with PD were retrospectively analyzed,who were admitted to our hospital between March 2019 and March 2022,and divided into FOG group(n=98)and non-FOG group(n=110)based on clinical symptoms.Clinical data were compared,then risk factors of FOG were screened by multivariate logistic regression model,and a nomogram model was established.Results The age,initial age of PD,duration of PD,scores of Parkinson's disease questionnaire(PDQ39),Hamilton depression scale(HAMD-17)and anxiety scale(HAMA-14),rapid eye movement sleep behavior disorder screening questionnaire(RBDSQ)and Pittsburgh sleep quality index(PSQI)in FOG group were significantly higher than the non-FOG group.Furthermore,visuospatial dysfunction,severity degree of swallowing,writing and turning over ability,modified Hoehn-Yahr(H-Y)grade were significantly higher,while score of Mini Mental State Examination(MMSE)was lower in the FOG group(P<0.05).Multivariate logistic regression showed that the RBDSQ score(OR=5.201,95%CI:3.124-7.523,P<0.01),PDQ39 score(OR=15.236,95%CI:11.102-19.625,P<0.01),visuospatial dysfunction(OR=2.326,95%CI:1.425-3.625,P<0.01)and H-Y grade(OR=8.659,95%CI:5.124-10.231,P<0.01)were the independent risk factors for FOG in patients with PD.The nomogram model was established using R software,with a total score of 120.The area under the curve(AUC)of the model for predicting FOG by receiver operating curve(ROC)was 0.867(95%CI:0.810-0.935,P<0.01),suggesting good predictive efficiency.The Hosmer-Lemeshow test showed that the goodness of fit was good(χ^(2)=2.635,P=0.642).The calibration curve showed that the predictive probability of the model was in good agreement with the actual incidence.The decision curve showed that the benefit was acceptable.Conclusion The incidence of FOG is high in patients with PD,and RBDSQ score
作者
傅亚明
潘昕然
王建伟
郑水红
FU Yaming;PAN Xinran;WANG Jianwei;ZHENG Shuihong(Jinhua Central Hospital,Jinhua 321000,China)
出处
《浙江实用医学》
2022年第5期399-404,共6页
Zhejiang Practical Medicine
基金
金华市科技计划项目(2021-3-087)。
