成年脊髓损伤患者功能结局的预测模型研究

doi:10.3969/j.issn.1006-9771.2019.10.003

《中国康复理论与实践》 ›› 2019, Vol. 25 ›› Issue (10): 1125-1132.doi: 10.3969/j.issn.1006-9771.2019.10.003

成年脊髓损伤患者功能结局的预测模型研究

崔尧^1,2, 丛芳^1,2, 李建军^1,2,3, 高峰^1,2, 杜良杰^1,2, 杨明亮^1,2

1.首都医科大学康复医学院，北京市 100068;
2.中国康复研究中心北京博爱医院，北京市100068;
3.中国康复科学所，北京市 100068

出版日期:2019-10-25 发布日期:2019-10-30
通讯作者: 李建军，E-mail: crrc100@163.com E-mail:crrc100@163.com
作者简介:崔尧(1988-)，男，汉族，陕西西安市人，硕士，主管治疗师，主要研究方向：康复治疗。
基金资助:
1.中国康复研究中心科研基金项目(No. 2016ZX-01)；2.财政部中央国家单位科研项目基金项目(No. 2014CZ-2)；3.北京市科技计划重大项目课题(No. D161100002816004)；4.首都卫生发展科研专项项目(No. 首发2018-1-6011)

Predictive Model for Functional Outcome of Adult Spinal Cord Injury

CUI Yao^1,2, CONG Fang^1,2, LI Jian-jun^1,2,3, GAO Feng^1,2, DU Liang-jie^1,2, YANG Ming-liang^1,2

1.Capital Medical University School of Rehabilitation Medicine, Beijing 100068, China;
2.Beijing Bo’ai Hospital, China Rehabilitation Research Center, Beijing 100068, China;
3.Chinese Institute of Rehabilitation Science, Beijing 100068, China

Published:2019-10-25 Online:2019-10-30
Contact: LI Jian-jun, E-mail: crrc100@163.com E-mail:crrc100@163.com
Supported by:
Supported by China Rehabilitation Research Center Scientific Research Project (No. 2016ZX-01), Ministry of Finance Funds for Research Projects in Central State Units (No. 2014CZ-2), Beijing Science and Technology Program (Major) (No. D161100002816004) and Capital Health Development Scientific Research Project (No. 2018-1-6011)

摘要/Abstract

摘要： 目的探索影响成年脊髓损伤患者功能结局的相关因素并构建预测模型。方法对2016年9月至2018年12月110例成年脊髓损伤截瘫住院患者的病历资料进行回顾性分析，系统收集可能影响功能预后的量化指标，包括年龄，住院天数，其他诊断数量，并发症数量，合并症数量，手术次数，发病到康复治疗介入的天数，出院和入院时的脊髓损伤神经学分类国际标准下肢运动总分(LEMS)、轻触觉(LT)总分、针刺觉(PP)总分以及改良Barthel指数(MBI)，计算出入院MBI总分(MBI_入院)的变化值及变换率，进行各变量间的单因素相关性分析，并对影响出院MBI总分(MBI_出院)及出入院MBI总分变化值(MBI_变化)的因素进行多元线性回归建模。结果 MBI_出院与MBI_入院、入院LEMS (LEMS_入院)、入院PP总分、入院LT总分、发病到康复治疗介入的天数、手术次数和合并症数量共7个变量显著相关；最优回归方程：MBI_出院= 28.24 + 0.52 × MBI_入院 + 0.24 × LEMS_入院 - 1.23 ×合并症数量(R² = 0.64, P < 0.001)。MBI_变化与MBI_入院、发病到康复治疗介入的天数和住院天数3个变量显著相关；最优回归方程：MBI_变化= 18.44 - 0.29 × MBI_入院 + 0.06 × 住院天数(R² = 0.29, P < 0.001)。结论脊髓损伤患者入院时功能状态好，运动评分高，合并症少，住院时间长，则预期功能恢复良好。

关键词: 脊髓损伤, 截瘫, 功能结局, 预测模型, 康复结局

Abstract: Objective To explore the related factors affecting the functional outcome of adult spinal cord injury and to establish a predictive model. Methods A retrospective analysis was made on the medical records of 110 adult spinal cord injured patients with paraplegia from September, 2016 to December, 2018. Quantitative indicators that affected functional outcome were systematically collected, including age, length of stay, number of other diagnostic, number of complications, number of comorbidities, number of operations, days from onset to rehabilitation intervention, and the total scores of Lower Extremity Motor Subscore (LEMS), light touch (LT), pin prick (PP) and modified Barthel Index (MBI) at admission (MBI_a) and discharge (MBI_d), the change values and change rates of MBI were calculated. The correlation coefficients among variables were analyzed. Multivariate linear regression models were established for the MBI total score at discharge and change of MBI score from admission to discharge (MBI_c). Results MBI_d was significantly correlated with MBI_a, the total score of LEMS at admission (LEMS_a), the total score of PP at admission, the total score of LT at admission, the number of days from onset to rehabilitation intervention, the number of operations and the number of comorbidities. The fitted regression equation was: MBI_d = 28.24 + 0.52 × MBI_a + 0.24 × LEMS_a - 1.23 × number of comorbidities (R² = 0.64, P < 0.001). The MBI_c was significantly correlated with MBI_a, the days from onset to rehabilitation intervention and the length of stay. The fitted regression equation was: MBI_c = 18.44 - 0.29 × MBI_a + 0.06 × length of stay (R² = 0.29, P < 0.001). Conclusion The spinal cord injured patients with better functional status, higher motor score and less comorbidity at admission, and longer hospitalization have better functional recovery.

Key words: spinal cord injury, paraplegia, functional outcome, prediction model, rehabilitation outcome

中图分类号:

R651.2

崔尧, 丛芳, 李建军, 高峰, 杜良杰, 杨明亮. 成年脊髓损伤患者功能结局的预测模型研究[J]. 《中国康复理论与实践》, 2019, 25(10): 1125-1132.

CUI Yao, CONG Fang, LI Jian-jun, GAO Feng, DU Liang-jie, YANG Ming-liang. Predictive Model for Functional Outcome of Adult Spinal Cord Injury[J]. 《Chinese Journal of Rehabilitation Theory and Practice》, 2019, 25(10): 1125-1132.

参考文献

1 李建军. 脊髓损伤神经学分类国际标准参考手册[M]. 北京:人民卫生出版社, 2008.
2 美国脊髓损伤协会，国际脊髓损伤学会. 脊髓损伤神经学分类国际标准(2011 年修订)[J]. 李建军，王方永,译.中国康复理论与实践, 2011, 17(10): 963-972.
3 李建军,杨明亮,杨德刚,等. “创伤性脊柱脊髓损伤评估、治疗与康复”专家共识[J]. 中国康复理论与实践, 2017, 23(3): 274-287.
4 梁志,赵超男,董云英,等. 脊髓损伤康复结局研究进展[J]. 中国康复理论与实践, 2003, 9(4): 239-240.
5 吴军发,吴毅,胡永善,等. 脊髓损伤患者康复治疗的疗效观察[J]. 中国康复医学杂志, 2005, 20(5): 358-359.
6 李丽,白玉龙,吴毅,等. 影响脊髓损伤患者出院时日常生活活动能力的相关因素分析[J]. 中华物理医学与康复杂志, 2010, 32(6): 442-445.
7 WilsonJ R, GrossmanR G, FrankowskiR F, et al. A clinical prediction model for long-term functional outcome after traumatic spinal cord injury based on acute clinical and imaging factors [J]. J Neurotrauma, 2012, 29(13): 2263-2271.
8 ScivolettoG, MorgantiB, DitunnoP, et al. Effects on age on spinal cord lesion patients' rehabilitation [J]. Spinal Cord, 2003, 41(8): 457-464.
9 McKinleyW, MeadeM A, KirshblumS, et al. Outcomes of early surgical management versus late or no surgical intervention after acute spinal cord injury [J]. Arch Phys Med Rehabil, 2004, 85(11): 1818-1825.
10 PostM W M, DallmeijerA J, AngenotE L D, et al. Duration and functional outcome of spinal cord injury rehabilitation in the Netherlands [J]. J Rehabil Res Dev, 2004, 42(3): 75-85.
11 NewP W. Functional outcomes and disability after nontraumatic spinal cord injury rehabilitation: results from a retrospective study [J]. Arch Phys Med Rehabil, 2005, 86(2): 250-261.
12 MckinleyW, SinhaA, KetchumJ, et al. Comparison of rehabilitation outcomes following vascular-related and traumatic spinal cord injury [J]. J Spinal Cord Med, 2011, 34(4): 410-415.
13 ScivolettoG, FarchiS, LaurenzaL, et al. Traumatic and non-traumatic spinal cord lesions: an Italian comparison of neurological and functional outcomes [J]. Spinal Cord, 2011, 49(3): 391-396.
14 ScivolettoG, FarchiS, LaurenzaL, et al. Impact of multiple injuries on functional and neurological outcomes of patients with spinal cord injury [J]. Scand J Trauma Resusc Emerg Med, 2013, 21(1): 42.
15 马斌荣. 医学科研中的统计方法[M]. 4版. 北京:科学出版社, 2012.
16 梁志,赵超男,董云英. 脑卒中康复结局预测的临床研究[J]. 中国康复理论与实践, 2002, 8(10): 577-599.
17 罗伯特·卡巴科弗. R语言实战(第2版) [M]. 北京:人民邮电出版社, 2016.
18 张铁军,陈兴林,刘振球. R语言与医学统计图形[M]. 北京:人民卫生出版社, 2018.
19 KimH S, JeongH J, KimM O. Changes of functional outcomes according to the degree of completeness of spinal cord injury [J]. Ann Rehabil Med, 2014, 38(3): 335-341.
20 GunesS, AytürY K, G?kH, et al. Demographic and clinical profile and functional outcomes of patients with spinal cord injury after rehabilitation [J]. Turk J Phys Med Rehab, 2017, 63(1): 66-71.
21 ZhangJ L, ChenJ, WuM, et al. Several time indicators and Barthel index relationships at different spinal cord injury levels [J]. Spinal Cord, 2015, 53(9): 679-681.
22 KayE, DeutschA, ChenD, et al. Effects of gender on inpatient rehabilitation outcomes inthe elderly with incomplete paraplegia from nontraumatic spinal cord injury [J]. J Spinal Cord Med, 2010, 33(4): 379-386.
23 HallK M, CohenM E, WrightJ, et al. Characteristics of the Functional Independence Measure in traumatic spinal cord injury [J]. Arch Phys Med Rehabil, 1999, 80(11): 1471-1476.
24 DijkersM. Quality of life after spinal cord injury: a meta analysis of the effects of disablement components [J]. Spinal Cord, 1999, 35(12): 829-840.
25 CurA, KeckM E, DietzV. Functional outcome following spinal cord injury significance of motor-evoked potentials and ASIA scores [J]. Arch Phys Med Rehabil, 1998, 79(1): 81-86.
26 王于领,梁崎,黄东锋,等. 脊髓独立测量量表Ⅱ中文版的开发及信度和效度研究[J]. 中国康复医学杂志, 2007, 22(8): 714-717.
27 叶超群,孙天胜,李建军, 等. 脊髓独立性评定及其第3版介绍[J]. 中国康复理论与实践, 2007, 13(10): 921-923.

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成年脊髓损伤患者功能结局的预测模型研究

Predictive Model for Functional Outcome of Adult Spinal Cord Injury

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