房颤合并糖尿病患者影响轻度认知功能障碍发生的多因素分析及预测模型建立

doi:10.3969/j.issn.1006-5725.2024.16.007

Abstract

Abstract:

Objective To explore the influencing factors of mild cognitive impairment （MCI） in patients with atrial fibrillation and diabetes mellitus， and to establish the prediction model， so as to provide guidance for the treatment of MCI in patients with atrial fibrillation and diabetes mellitus. Methods 199 patients with atrial fibrillation and diabetes diagnosed in the second ward of Cardiovascular Department of the Fifth Affiliated Hospital of Zhengzhou University from January 2023 to January 2024 were analyzed. The related factors of MCI in patients with atrial fibrillation and diabetes mellitus were analyzed by univariate analysis and multivariate logistic regression. According to the results of multivariate logistic regression analysis， the prediction model of MCI in patients with atrial fibrillation and diabetes mellitus was established. Results Univariate analysis showed that age （P =0.002 3）， homocysteine （P < 0.000 1）， fasting blood glucose （P = 0.022 5）， glycated hemoglobin （P = 0.006 6）， and blood uric acid （P = 0.032 2） were the influencing factors of MCI. Multivariate logistic regression analysis： age （OR = 1.08， P = 0.000 4）， homocysteine （OR = 1.37， P < 0.000 1）， fasting blood glucose （OR = 1.22， P =0.023 5）， glycated hemoglobin （OR = 1.61， P = 0.004 2）， and blood uric acid （OR = 1.29， P = 0.009 1） were the independent influencing factors of MCI. The optimal threshold is when the Youden index （YI = sensitivity + specificity） is maximum. At the optimal threshold， the sensitivity was 0.74， the specificity was 0.80， and the area under the curve （AUC） was 0.809， indicating that the model can effectively predict the occurrence of MCI. Conclusion Age， fasting blood glucose， blood homocysteine， blood uric acid and glycosylated hemoglobin are independent risk factors for MCI in patients with atrial fibrillation and diabetes. The clinical prediction model based on multivariate logistic regression has a certain predictive value for the occurrence of MCI in patients with atrial fibrillation and diabetes mellitus.

Key words: atrial fibrillation, diabetes mellitus, mild cognitive impairment, prediction model, ROC

CLC Number:

R499

Xin HUANG,Pu ZHANG,Yu GAO,Kai CHEN,Xiaofeng LI,Huiyang GU,Xue. LIANG. Multivariate analysis and prediction model of mild cognitive impairment in patients with atrial fibrillation and diabetes mellitus[J]. The Journal of Practical Medicine, 2024, 40(16): 2236-2243.

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References 34

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指标	对照组（n = 138）	MCI组（n = 61）	t/χ²值	P值
年龄（岁）	59.19 ± 9.05	63.21 ± 5.92	3.18	0.002
BMI（kg/m²）	23.77 ± 3.85	24.27 ± 4.62	0.80	0.424
肌酐（μmol/L）	70.30 ± 12.91	75.16 ± 25.17	1.80	0.073
尿素氮（mmol/L）	6.54 ± 1.53	7.11 ± 3.24	1.69	0.093
空腹血糖（mmol/L）	6.72 ± 1.89	7.37 ± 1.65	2.33	0.021
糖化血红蛋白（%）	7.10 ± 0.94	7.54 ± 1.15	2.81	0.005
血尿酸（mg/dL）	4.92 ± 1.85	5.55 ± 1.87	2.19	0.030
同型半胱氨酸（μmol/L）	12.05 ± 2.59	15.70 ± 5.06	6.73	< 0.001
性别［例（%）］			0.63	0.428
男	113（81.88）	47（77.05）
女	25（18.12）	14（22.95）
吸烟史［例（%）］			2.79	0.095
否	72（52.17）	24（39.34）
是	66（47.83）	37（60.66）
饮酒史［例（%）］			0.13	0.715
否	74（53.62）	31（50.82）
是	64（46.38）	30（49.18）
教育经历［例（%）］			4.62	0.099
文盲	14（10.14）	13（21.31）
小学	29（21.01）	10（16.39）
初中及以上	95（68.84）	38（62.30）
高血压［例（%）］			0.03	0.862
否	57（41.30）	26（42.62）
是	81（58.70）	35（57.38）
冠心病［例（%）］			1.02	0.311
否	83（60.14）	32（52.46）
是	55（39.86）	29（47.54）
心力衰竭［例（%）］			0.12	0.728
否	127（92.03）	57（93.44）
是	11（7.97）	4（6.56）
睡眠呼吸暂停综合征［例（%）］			2.48	0.115
否	80（57.97）	28（45.90）
是	58（42.03）	33（54.10）

项目	单因素分析		多因素分析
项目	OR（95%CI）	P值	OR（95%CI）	P值
年龄	1.06（1.02 ~ 1.10）	0.002 3	1.08（1.04 ~ 1.13）	0.000 4
空腹血糖	1.21（1.03 ~ 1.44）	0.022 5	1.22（1.03 ~ 1.45）	0.023 5
糖化血红蛋白	1.51（1.12 ~ 2.04）	0.006 6	1.61（1.16 ~ 2.22）	0.004 2
血尿酸	1.20（1.02 ~ 1.43）	0.032 2	1.29（1.06 ~ 1.55）	0.009 1
同型半胱氨酸	1.34（1.19 ~ 1.49）	< 0.000 1	1.37（1.21 ~ 1.55）	< 0.000 1

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Multivariate analysis and prediction model of mild cognitive impairment in patients with atrial fibrillation and diabetes mellitus

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