特定转移Cox模型在阿尔茨海默病进程研究中的应用

许晓萌; 孙倩倩; 杨蓓; 马彩云; 余红梅

doi:10.16462/j.cnki.zhjbkz.2016.09.024

特定转移Cox模型在阿尔茨海默病进程研究中的应用

doi: 10.16462/j.cnki.zhjbkz.2016.09.024

山西医科大学公共卫生学院卫生统计教研室, 山西太原 030001

基金项目:

国家自然科学基金（81373106）

详细信息

作者简介:
许晓萌(1992-),女,河北邯郸人,在读硕士研究生。主要研究方向:阿尔茨海默病生存分析研究。

中图分类号: R742;R181
计量
- 文章访问数: 329
- HTML全文浏览量: 79
- PDF下载量: 21
- 被引次数: 0
出版历程
- 收稿日期: 2016-01-23
- 修回日期: 2016-05-02

Application of a transition-specific Cox model in alzheimer's disease progression

Department of Health Statistics, School of Public Health, Shanxi Medical University, Taiyuan 030001, China

摘要

摘要: 目的将特定转移Cox模型应用于老年人阿尔茨海默病（alzheimer's disease，AD）进程研究中，探讨AD不同阶段转归的影响因素。方法利用太原市三个社区2010年10月~2014年10月的9次随访数据，根据AD进程中的五个状态结构，包括轻度认知损害（mild cognitive impairment，MCI）、AD、失访或删失、死于AD（DEATH）和死于其他原因，拟合特定转移Cox模型，分析AD进程中各状态向其他状态转移的影响因素。结果按照α=0.05水准，年龄（HR=0.68，95% CI：0.52～0.90）、性别（HR=2.13，95% CI：1.32～3.43）、吸烟（HR=1.93，95% CI：1.25～2.98）、高血压（HR=2.51，95% CI：1.55～4.08）、高血脂（HR=2.03，95% CI：1.25～3.30）、糖尿病（HR=1.71，95% CI：1.10～2.67）对MCI→AD转移有统计学意义；亲属痴呆情况（HR=4.11，95% CI：1.33～12.69）对MCI→DEATH转移有统计学意义；亲属痴呆情况（HR=5.88，95% CI：1.91～18.06）、高血压（HR=7.06，95% CI：1.60～31.26）对AD→DEATH转移有统计学意义。结论根据AD进程中各状态间转移的主要影响因素，采取疾病分状态的重点防治措施，延缓疾病进展。
- 阿尔茨海默病 /
- 认知障碍 /
- 模型,统计学
Abstract: Objective To apply the transition-specific Cox model in Alzheimer's disease(AD) progression among the elders and to explore factors influencing each transition during different AD progression stages. Methods Data were collected from nine follow-up visits in three communities in Taiyuan City from October 2010 to October 2014. Based on the five state structures in AD progression, including mild cognitive impairment(MCI), AD, loss to follow up, die of AD(DEATH) and die of other else causes, the transition-specific Cox model was fitted to identify influencing factors for every possible transition in AD progression. Results At the significance level of 0.05, age (HR=0.68, 95% CI:0.52-0.90), sex(HR=2.13, 95% CI:1.32-3.43), smoking(HR=1.93,95% CI:1.25-2.98), hypertension(HR=2.51,95% CI:1.55-4.08), high cholesterol(HR=2.03,95% CI:1.25-3.30), and diabetes(HR=1.71,95% CI:1.10-2.67) were statistically significant for transition from MCI to AD; relatives with dementia (HR=4.11, 95% CI: 1.33-12.69)was statistically significant for transition from MCI to DEATH;relatives with dementia (HR=5.88, 95% CI: 1.91-18.06)and hypertension(HR=7.06, 95% CI:1.60-31.26) were statistically significant for transition from AD to DEATH. Conclusions Prevention measures should be taken based on the main factors of each transition in AD progression to delay the disease deterioration.
- Alzheimer's disease /
- Cognition disorders /
- Models,statistical

HTML全文

参考文献(17)

杨珊珊,周立业,梁瑞峰,等. 多状态Markov模型在社区老年人轻度认知损害转归分析中的应用 [J]. 中华流行病学杂志, 2011,32(1):25-28.

Larson EB, Shadlen MF, Wang L, et al. Survival after initial diagnosis of Alzheimer disease [J]. Ann Intern Med, 2004,140(7):501-509.

田金洲,时晶,张学凯,等. 2011年美国阿尔茨海默病最新诊断标准解读 [J]. 中国医学前沿杂志(电子版), 2011,3(4

): 91-100.

Albert MS, DeKosky ST, Dickson D, et al. The diagnosis of mild cognitive impairment due to Alzheimer's disease: recommendations from the National Institute on Aging-Alzheimer's Association workgroups on diagnostic guidelines for Alzheimer's disease [J]. Alzheimers Dement, 2011, 7(3):270-279.

Nasreddine ZS, Phillips NA, Bedirian V, et al. The Montreal Cognitive Assessment, MoCA: a brief screening tool for mild cognitive impairment [J]. J Am Geriatr Soc, 2005,53(4):695- 699.

de Wreede LC, Fiocco M, Putter H. The mstate package for estimation and prediction in non- and semi-parametric multi-state and competing risks models [J]. Comput Methods Programs Biomed, 2010,99(3):261-274.

Andersen PK, Borgan O, Gill PD, et al. Statistical models based on counting processes(2nded)[M]. Germany:Springer, 1993.

de Wreede LC, Fiocco M, Putter H. Mstate: an R package for the analysis of competing risks and multi-state models [J]. J Stat Softw, 2011,38(7):1-30.

Aguirre-Hernandez R, Farewell VT. A Pearson-type goodness-of-fit test for stationary and time-continuous Markov regression models [J]. Stat Med, 2002,21(13):1899-1911.

赵建刚,邬天凤,韩峰梅,等. 天津市社区老年人轻度认知功能障碍人口学特征分析 [J]. 中华疾病控制杂志, 2015,19(4):330-333.

吴一峰,黄河浪. 阿尔茨海默病的危险因素研究进展 [J]. 中华疾病控制杂志, 2011,15(4):336-339.

Reinhard H, Heike K, Frank J.Risk factors and early signs of Alzheimer's disease in a family study sample [J]. Eur Arch Psychiatry Clin Neurosci, 2006,256(1):28-36.

Unverzagt FW, Ogunniyi A, Taler V, et al. Incidence and risk factors for cognitive impairment no dementia and mild cognitive impairment in African Americans [J]. Alzheimer Dis Assoc Disord, 2011,25(1):4-10.

王华丽,于欣. 中国阿尔茨海默病的流行病学现状 [J]. 中国全科医师杂志, 2006, 5(6):358-360.

Aggarwal NT, Bienias JL, Bennett DA,et al.The relation of cigarette smoking to incident Alzheimer's disease in a biracial urban community population [J]. Neuroepidemiology, 2006,26(3):140-146.

王荫华. 阿尔茨海默病的危险因素 [J]. 中华神经科杂志, 2003, 36(6):477-479.

张玉琦,徐文炜,程灶火,等. 阿尔茨海默病的遗传流行病学研究 [J]. 现代预防医学, 2013,40(8):1401-1407.

施引文献

资源附件(0)

访问统计