老年心脏病患者认知障碍风险列线图预测模型构建

doi:10.3969/j.issn.1006-9771.2026.09.001

《中国康复理论与实践》 ›› 2026, Vol. 32 ›› Issue (9): 993-1002.doi: 10.3969/j.issn.1006-9771.2026.09.001

老年心脏病患者认知障碍风险列线图预测模型构建

王晓蕾¹, 赵晓晴², 陈澍盈², 张明皓¹, 周笑昱², 李海燕¹, 张建华², 井淇¹(), 董志伟¹()

¹ 山东第二医科大学管理学院，山东潍坊市 261053
² 山东第二医科大学公共卫生学院，山东潍坊市 261053

收稿日期:2025-02-18 修回日期:2025-10-13 接受日期:2025-10-21 出版日期:2026-09-25 发布日期:2026-09-20
通讯作者: 井淇(1988-)，男，汉族，山东临朐县人，博士，教授，主要研究方向：卫生政策与管理评价、康复政策与管理，E-mail： jingq@sdsmu.edu.cn；
董志伟(1989-)，男，汉族，山东寿光市人，博士，讲师，主要研究方向：社会保障，卫生经济。E-mail： dongzhiwei1989@outlook.com
作者简介:王晓蕾(1998-)，女，汉族，山东诸城市人，硕士研究生，主要研究方向：卫生事业管理。
基金资助:
国家自然科学基金面上项目(72374156);国家自然科学基金青年科学基金项目(72004165);山东省高等学校"青创团队计划"团队研究课题(2022RW075)

Development of a nomogram for predicting cognitive impairment risk among older adults with heart disease

Wang Xiaolei¹, Zhao Xiaoqing², Chen Shuying², Zhang Minghao¹, Zhou Xiaoyu², Li Haiyan¹, Zhang Jianhua², Jing Qi¹(), Dong Zhiwei¹()

¹ School of Management, Shandong Second Medical University, Weifang, Shandong 261053, China
² School of Public Health, Shandong Second Medical University, Weifang, Shandong 261053, China

Received:2025-02-18 Revised:2025-10-13 Accepted:2025-10-21 Published:2026-09-25 Online:2026-09-20
Contact: Dong Zhiwei, E-mail: dongzhiwei1989@outlook.com
Supported by:
National Natural Science Foundation of China (General)(72374156);National Natural Science Foundation of China (Youth)(72004165);Shandong Province Higher Education Institutions "Youth Creative Team Program" Team Research Project(2022RW075)

摘要/Abstract

摘要：

目的构建并验证老年心脏病患者并发认知障碍风险的列线图预测模型。

方法分析中国健康与养老追踪调查2020年数据中2 673例受访者的自我报告数据。分为建模集1 871例和验证集802例，采用自我报告问卷调查心脏病发生情况。采用Logistic回归确定影响因素，应用R软件建立预测老年心脏病患者并发认知障碍风险的列线图模型；采用Bootstrap法进行内部验证，并利用随机划分的验证集评价模型性能，采用受试者工作特征(ROC)曲线下面积和校准曲线评价模型的预测性能。

结果共纳入老年心脏病患者2 673例，其中训练集中认知障碍患者315例。Lasso回归分析结果显示年龄、教育、居住地、工具性日常生活活动能力、抑郁是老年心脏病患者并发认知障碍的预测因素；以此5个变量建立老年心脏病患者并发认知障碍的风险预测模型，预测模型在训练集和验证集下的ROC曲线下面积分别为0.827 (95%CI 0.804~0.850)和0.847 (95%CI 0.812~0.882)；Hosmer-Lemeshow检验值分别为P = 0.154和P = 0.716；校准曲线显示预测值和实际值之间存在显著一致性。决策曲线分析显示该模型具有良好的净效益和预测准确性。

结论列线图预测模型可为老年心脏病患者认知障碍风险筛查和早期干预提供参考。

关键词: 老年人, 心脏病, 认知障碍, 抑郁, 列线图, 预测模型

Abstract:

Objective To develop and validate a nomogram for predicting the risk of concurrent cognitive impairment in older adults with heart disease.

Methods Self-reported data from 2 673 respondents in the 2020 China Health and Retirement Longitudinal Study were analyzed. The participants were randomly divided into a training set (n = 1 871) and a validation set (n = 802). Heart disease status was determined using a self-report questionnaire. Logistic regression analysis was performed to identify predictors, and a nomogram for predicting the risk of concurrent cognitive impairment in older adults with heart disease was developed using R software. Bootstrap resampling was used for internal validation, and model performance was further evaluated in the randomly split validation set. The predictive performance of the model was assessed using the area under the receiver operating characteristic curve (AUC) and calibration curves..

Results A total of 2 673 older adults with heart disease were included, out of whom 315 participants in the training set had cognitive impairment. Lasso regression analysis identified age, education level, place of residence, instrumental activities of daily living and depression as predictors of concurrent cognitive impairment. A prediction model incorporating these five variables was constructed. The AUC were 0.827 (95%CI 0.804 to 0.850) in the training set and 0.847 (95%CI 0.812 to 0.882) in the validation set. The Hosmer-Lemeshow test yielded P = 0.154 and P = 0.716 in the training and validation sets, respectively. Calibration curves showed good agreement between predicted and observed probabilities. Decision curve analysis indicated that the model provided favorable net benefit and predictive performance.

Conclusion The nomogram may provide a useful reference for risk screening and early intervention for cognitive impairment in older adults with heart disease.

Key words: older adults, heart disease, cognitive impairment, depression, nomogram, predictive model

中图分类号:

R541

王晓蕾, 赵晓晴, 陈澍盈, 张明皓, 周笑昱, 李海燕, 张建华, 井淇, 董志伟. 老年心脏病患者认知障碍风险列线图预测模型构建[J]. 《中国康复理论与实践》, 2026, 32(9): 993-1002.

Wang Xiaolei, Zhao Xiaoqing, Chen Shuying, Zhang Minghao, Zhou Xiaoyu, Li Haiyan, Zhang Jianhua, Jing Qi, Dong Zhiwei. Development of a nomogram for predicting cognitive impairment risk among older adults with heart disease[J]. Chinese Journal of Rehabilitation Theory and Practice, 2026, 32(9): 993-1002.

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变量	总样本(n = 2673)	训练集(n = 1871)	验证集(n = 802)	χ²值	P值
性别				0.107	0.744
女	1456	1023	433
男	1217	848	369
年龄				3.937	0.140
60~< 70岁	1747	1223	524
70~< 80岁	805	554	251
≥ 80岁	121	94	27
受教育程度				6.005	0.199
文盲	674	479	195
小学及以下	614	438	176
初中	35	26	9
高中或职高	841	594	247
大专及以上	509	334	175
婚姻状况				0.114	0.736
无配偶	544	384	160
有配偶	2129	1487	642
居住地				0.985	0.321
农村	1857	1289	568
城市	816	582	234
吸烟				0.324	0.569
否	2044	1425	619
是	629	446	183
饮酒				0.004	0.947
否	1844	1290	554
是	829	581	248
夜间睡眠				0.250	0.617
异常	751	531	220
正常	1922	1340	582
参与社交活动				1.701	0.192
否	1358	966	392
是	1315	905	410
进行日常活动				0.065	0.799
否	303	214	89
是	2370	1657	713
ADL				2.447	0.118
正常	1846	1275	571
受损	827	596	231
IADL				1.895	0.169
正常	1792	1239	553
受损	881	632	249
抑郁				0.247	0.620
否	1466	1032	434
是	1207	839	368
自评健康				4.743	0.315
很好	176	129	47
好	232	153	79
一般	1301	911	390
差	691	477	214
很差	273	201	72
并发症
心血管及代谢性疾病				0.928	0.335
无	2276	1585	691
有	397	286	111
呼吸系统疾病				0.026	0.873
无	2510	1756	754
有	163	115	48
消化系统疾病				0.360	0.548
无	2385	1665	720
有	288	206	82
神经系统疾病				1.021	0.312
无	2600	1816	784
有	73	55	18
风湿免疫性疾病				0.003	0.960
无	2351	1646	705
有	322	225	97
癌症				0.144	0.705
无	2661	1862	799
有	12	9	3

自变量	赋值
年龄	60~< 70 = 1；70~< 80 = 2；≥ 80 = 3
受教育程度	文盲 = 1；小学及以下 = 2；初中 = 3；高中 = 4；大学专科及以上 = 5
居住地	农村 = 0；城市 = 1
IADL	正常 = 0；受损 = 1
抑郁	否 = 0；是 = 1

预测变量	β	SE	Wald/χ²值	P值	OR(95%CI)
常数	-1.038	0.148	49.040	< 0.001	0.354
受教育程度(以文盲为参照)			178.906	< 0.001
小学及以下	-1.432	0.172	69.341	< 0.001	0.239(0.171~0.335)
初中	-2.606	1.048	6.183	0.013	0.074(0.009~0.576)
高中或职高	-2.135	0.201	112.988	< 0.001	0.118(0.080~0.175)
大专及以上	-3.014	0.378	63.498	< 0.001	0.049(0.023~0.103)
年龄(以60~< 70岁为参照)			34.372	< 0.001
70~< 80岁	0.422	0.156	7.337	0.007	1.525(1.124~2.071)
≥ 80岁	1.634	0.289	31.885	< 0.001	5.125(2.906~9.038)
居住地类型(以农村为参照)	-0.838	0.211	15.715	< 0.001	0.433(0.286~0.655)
IADL(以正常为参照)	0.571	0.148	14.973	< 0.001	1.771(1.326~2.365)
抑郁(以否为参照)	0.603	0.151	16.038	< 0.001	1.827(1.360~2.454)

老年心脏病患者认知障碍风险列线图预测模型构建

Development of a nomogram for predicting cognitive impairment risk among older adults with heart disease

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