Construction and validation of a risk assessment model for mild cognitive impairment in Chinese elderly based on Meta-analysis
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摘要:
目的 构建中国老年人轻度认知障碍(mild cognitive impairment, MCI)风险评估模型，并进行模型效果验证。 方法 通过检索既往文献及Meta分析的方法获得中国老年人群MCI发病的影响因素及暴露率，运用Rothman-Keller模型构建中国老年人群MCI风险评估模型。模型验证数据来源于山东省蓬莱市人民医院及荣成市人民医院健康体检中心(2021年11月―2022年6月)，共收集2 545名60岁及以上老年人信息用于模型验证。运用Stata 17.0统计软件计算受试者工作特征(receiver operating characteristic，ROC)曲线下面积(area under the curve, AUC)、灵敏度、特异度验证模型效果。 结果 Meta分析共纳入49篇文献，建立的Rothman-Keller模型纳入因素包括性别、年龄、痴呆家族史、受教育程度、吸烟、饮酒、锻炼、独居、失眠、超重/肥胖、高血压、高血脂、糖尿病、心血管疾病、脑血管疾病。模型AUC为0.772，灵敏度和特异度分别为78.04%和63.95%。 结论 建立的中国老年人群MCI风险评估模型效果较好，其高灵敏度的特点可以用于国内基层社区人群中MCI的识别，有助于及早发现高危人群并采取措施，预防MCI及痴呆的发生和发展。 -
关键词:
- 轻度认知障碍 /
- Meta分析 /
- Rothman-Keller模型 /
- 风险评估
Abstract:Objective To establish a risk assessment model for mild cognitive impairment (MCI) in elderly Chinese individuals and verify the effect of the model. Methods Meta-analysis was used to derive influencing factors and exposure rates for MCI in the Chinese elderly from existing literature. The Rothman-Keller model was used to construct the risk assessment model of MCI in the Chinese elderly population. Verification data were collected from the Health Examination Center of Penglai People′s Hospital and Rongcheng People′s Hospital of Shandong Province, spanning November 2021 to June 2022, and encompassed 2 545 elderly people aged 60 and above. The model′s efficacy was verified by calculating the area under the curve (AUC), sensitivity, and specificity of the receiver operating characteristic (ROC) curve using Stata 17.0. Results A total of 49 articles were included in the Meta-analysis. Gender, age, family history of dementia, education, smoking, drinking, exercise, living alone, insomnia, overweight/obesity, hypertension, hyperlipidemia, diabetes, cardiovascular diseases, and cerebrovascular diseases were included to establish the Rothman-Keller model. The AUC of the model was 0.772, and the sensitivity and specificity were 78.04% and 63.95%, respectively. Conclusions The MCI risk assessment model established in this study proved effective for the elderly population in China. With its high sensitivity, this model can be used to identify MCI in the community population, facilitating early detection of high-risk people and enabling proactive measures to prevent the development of MCI and dementia. -
Key words:
- Mild cognitive impairment /
- Meta analysis /
- Rothman-Keller model /
- Risk assessment
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表 1 基于Rothman-Keller建立的MCI风险评估模型参数
Table 1. MCI risk assessment model parameters based on Rothman-Keller
影响因素 RR值 Pi ρ S 影响因素 RR值 Pi ρ S 性别 失眠 男 0.778 0.465 1.115 0.868 是 1.402 0.481 0.838 1.175 女 1.000 0.535 1.115 否 1.000 0.519 0.838 年龄/岁 超重/肥胖 ≥70 2.431 0.536 0.566 1.376 是 1.431 0.463 0.834 1.193 ≥60~ < 70 1.000 0.464 0.566 否 1.000 0.537 0.834 痴呆家族史 高血压 是 3.228 0.011 0.976 3.151 是 1.731 0.607 0.693 1.199 否 1.000 0.989 0.976 否 1.000 0.393 0.693 受教育程度 高血脂 初中及以上 0.428 0.599 1.521 0.651 是 1.722 0.241 0.852 1.467 小学及以下 1.000 0.401 1.521 否 1.000 0.759 0.852 吸烟 糖尿病 是 1.214 0.259 0.947 1.150 是 1.495 0.196 0.912 1.363 否 1.000 0.741 0.947 否 1.000 0.804 0.912 饮酒 心血管疾病 是 1.165 0.201 0.968 1.128 是 1.671 0.071 0.955 1.595 否 1.000 0.799 0.968 否 1.000 0.929 0.955 锻炼 脑血管疾病 是 0.496 0.756 1.616 0.801 是 2.309 0.109 0.875 2.021 否 1.000 0.244 1.616 否 1.000 0.891 0.875 独居 是 2.816 0.081 0.872 2.455 否 1.000 0.919 0.872 注：1. MCI：轻度认知障碍。2. RR：相对危险度。3. Pi为影响因素的暴露率。4. ρ为基准发病比例。5. S为危险分数。 
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