摘要
目的:探讨中性粒细胞/淋巴细胞比值(neutrophil⁃to⁃lymphocyte ratio,NLR)和预后营养指数(prognostic nutritional in⁃dex,PNI)对帕金森病(Parkinson’s disease,PD)患者伴抑郁中的预测价值,构建并验证PD患者伴发抑郁风险的列线图预测模型。方法:连续收集就诊于南京医科大学附属淮安第一医院的182例PD患者为PD组,根据汉密尔顿抑郁量表24项(hamilton depression rating scale⁃24,HAMD⁃24)评分将PD患者分为PD不伴抑郁组和PD伴抑郁组,并选取同期175例健康体检人群为健康对照组,进行组间临床资料差异比较,采用多因素Logistic回归分析探讨PD患者伴发抑郁的影响因素,并据此构建和验证个体化预测PD患者伴发抑郁风险的列线图模型。结果:PD组PNI低于健康对照组,而NLR高于健康对照组(P<0.05)。PD伴抑郁组NLR、左旋多巴胺等效剂量(levodopa equivalant dose,LED)、Hoehn⁃Yahr分期、病程和统一帕金森病评定量表第三部分(partⅢof the unified Parkinson’s disease rating scale,UPDRS⁃Ⅲ)均高于PD不伴抑郁组,而PNI低于PD不伴抑郁组(P<0.05)。多因素Logistic回归分析结果显示NLR、LED和UPDRS⁃Ⅲ评分的是PD患者伴发抑郁的独立危险因素,而PNI是PD患者伴发抑郁的独立保护因素。基于多因素Logistic回归分析结果构建个体化预测PD患者伴发抑郁风险的列线图模型,该列线图模型的受试者工作特征(reciever operating characteristic curve,ROC)曲线下面积(area under curve,AUC)为0.835(95%CI:0.776~0.893,P<0.01)。Hosmer⁃Lemeshow拟合度检验结果为χ^(2)=11.576(P>0.05)。结论:基于PNI、NLR、LED和UPDRS⁃Ⅲ构建的个体化列线图模型可有效预测PD患者伴发抑郁的风险,具有一定的临床应用价值。
Objective:To explore the predictive value of neutrophil⁃to⁃lymphocyte ratio(NLR)and prognostic nutritional index(PNI)in predicting depression in patients with Parkinson’s disease(PD),and to construct and verify a nomogram prediction model for the risk of PD patients with depression.Methods:182 PD patients treated at the the Affiliated Huai’an No.1 People’s Hospital of Nanjing Medical University were continuously collected as the PD group.According to the hamilton depression rating scale(HAMD)⁃24 score,the patients with PD were divided into two groups:PD without depression group and PD with depression group.At the same time,175 healthy individuals undergoing physical examinations were selected as the healthy control group.The differences in clinical data between groups were compared,and a multivariate logistic regression analysis was used to explore the influencing factors of depression in PD patients with depression,and based on this,a personalized nomogram model for predicting the risk of depression in PD patients was constructed and validated.Results:Compared with the healthy control group,patients with PD showed lower PNI but higher NLR(P<0.05).Compared with PD patients without depression,PD patients with depression showed higher levels of NLR,levodopa equivalant dose(LED),Hoehn⁃Yahr stage,course of disease,and partⅢof the unified parkinson’s disease rating scale(UPDRS⁃Ⅲ);but lower level of PNI(P<0.05).The results of multivariate logistic regression analysis showed that NLR,LED and UPDRS⁃Ⅲwere independent risk factors for PD patients with depression;while PNI was an independent protective factor for PD patients with depression.Based on the results of multivariate logistic regression analysis,a individualized nomogram model was constructed to predict the risk of depression in PD patients.The area under the ROC curve(AUC)of the nomogram model was 0.835(95%CI:0.776⁃0.893,P<0.01).The Hosmer⁃Lemeshow test showedχ^(2)=11.576(P>0.05).Conclusion:The individualized nomogram model based on PNI,NLR,LED and UPDRS⁃Ⅲcan effectively predict the risk of depression in PD patients and has certain clinical application value.
作者
陈宇鲜
许富贵
乙红艳
梁晓静
杨秀
魏明
佟强
CHEN Yuxian;XU Fugui;YI Hongyan;LIANG Xiaojing;YANG Xiu;WEI Ming;TONG Qiang(Department of Neurology,the Affiliated Huai’an NO.1 People’s Hospital of Nanjing Medical University,Huai’an 223300;Department of Neurology,the Fifth People’s Hospital of Huai’an,Huai’an 223300,China)
出处
《南京医科大学学报（自然科学版）》
CAS
北大核心
2024年第3期352-359,422,共9页
Journal of Nanjing Medical University(Natural Sciences)
基金
江苏省自然科学基金(BK20191212)
江苏省卫健委面上项目(M2022082)。
关键词
帕金森病
中性粒细胞/淋巴细胞比值
预后营养指数
抑郁
列线图
Parkinson’s disease
neutrophil⁃to⁃lymphocyte ratio
prognostic nutritional index
depression
nomogram
