老年脑卒中患者口腔衰弱风险预测模型构建

刘威龙; 王晓燕; 杨思佳; 张希萍

doi:10.16766/j.cnki.issn.1674-4152.004447

老年脑卒中患者口腔衰弱风险预测模型构建

doi: 10.16766/j.cnki.issn.1674-4152.004447

西湖大学附属杭州市第一人民医院急诊科，浙江杭州 310006

基金项目:

浙江省医药卫生科技计划项目 2025KY1056

详细信息

通讯作者:
刘威龙，E-mail: yjyvip01@163.com

中图分类号: 743.3R787
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出版历程
- 收稿日期: 2025-12-03

Analysis of factors influencing oral frailty in elderly stroke patients

Department of Emergency, Affiliated Hangzhou First People's Hospital, School of Medicine, Westlake University, Hangzhou, Zhejiang 310006, China

摘要

摘要: 目的探究老年脑卒中患者口腔衰弱(OF)的危险因素并构建风险预测模型，为OF预防与管理提供参考。方法选取2025年1—10月西湖大学附属杭州市第一人民医院收治的286例老年脑卒中患者为研究对象。采用一般资料调查问卷、口腔衰弱筛查量表、微营养评定量表、衰弱量表和简版老年抑郁评估量表进行调查，通过多因素logistic回归分析研究老年脑卒中患者OF的危险因素并构建风险预测模型，采用Homser-Lemeshow检验和ROC曲线验证模型的拟合优度及预测效能。结果 286例老年脑卒中患者中发生OF 179例，占62.59%。Logistic回归分析显示，年龄(OR=1.607)、女性(OR=1.283)、吸烟(OR=1.519)、合并糖尿病(OR=4.022)、身体衰弱(OR=3.108)、营养不良(OR=4.674)、抑郁(OR=2.860)均是老年脑卒中患者OF的影响因素(P < 0.05)。基于以上因素构建OF的风险预测模型，ROC曲线下面积为0.916(95% CI: 0.891~0.943)，灵敏度为0.890，特异度为0.822。Homser-Lemeshow拟合优度检验(χ²=5.031，P=0.722)。结论老年脑卒中患者OF发生率较高，高龄、女性、吸烟、合并糖尿病、身体衰弱、营养不良、抑郁的老年脑卒中患者OF风险较高，预测模型具有较好的预测效能，利于临床人员识别OF高危患者。
- 脑卒中 /
- 老年 /
- 口腔衰弱 /
- 口腔健康 /
- 影响因素
Abstract: Objective To identify the risk factors for oral frailty (OF) in elderly stroke patients and to develop a risk prediction model, thereby providing a reference for OF prevention and management. Methods The study subjects were elderly stroke patients (n=286) admitted to the First People ' s Hospital of Hangzhou Affiliated to Westlake University from January to October 2025. A general information questionnaire, oral frailty screening scale, micronutrient assessment scale, frailty scale, and the simplified version of the geriatric depression rating scale (GDRS) were used for data collection. Multivariate logistic regression analysis was conducted to identify the risk factors for osteoporosis in elderly stroke patients, followed by the construction of a predictive model. The model ' s goodness of fit and predictive performance were validated using the Homser-Lemeshow test and ROC curve analysis. Results Among 286 patients, 179 (62.59%) developed OF. Logistic regression analysis: age (OR=1.607), female sex(OR=1.283), smoking history (OR=1.519), comorbid diabetes (OR=4.022), physical frailty (OR=3.108), malnutrition (OR=4.674), and depression (OR=2.860) were factors influencing OF in elderly stroke patients (P < 0.05). A risk prediction model of OF was constructed, with an area under the ROC curve of 0.916 (95% CI: 0.891-0.943), sensitivity of 0.890, specificity of 0.822. The Homser-Lemeshow goodness-of-fit test indicated good model fit (χ²=5.031, P=0.722). Conclusion The incidence of OF in elderly stroke patients is high and is mainly related to factors such as advanced age, smoking history, diabetes, physical weakness, malnutrition, and depression. It is recommended to develop individualized oral management plans to prevent or delay the occurrence of OF.
- Stroke /
- Elderly /
- Oral frailty /
- Oral health /
- Influencing factors
利益冲突 无

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图 1 老年脑卒中患者OF发生风险的列线图预测模型

Figure 1. Nomogram prediction model for the risk of oral frailty in elderly stroke patients

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图 2 老年脑卒中患者OF预测模型的ROC曲线

Figure 2. ROC curve of the prediction model for oral frailty in elderly stroke patients

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表 1 老年脑卒中患者OF影响因素单因素分析[例(%)]

Table 1. Univariate analysis of influencing factors for oral frailty in elderly stroke patients [cases (%)]

项目	口腔衰弱		统计量	P值
项目	有(n=179)	无(n=107)	统计量	P值
年龄[M(P₂₅, P₇₅)，岁]	63(60, 68)	70(64, 78)	6.795^a	＜0.001
性别[例(%)]			6.293^b	0.012
男	83(46.37)	66(61.68)
女	96(53.63)	41(38.32)
婚姻状况[例(%)]			0.708^b	0.399
已婚	138(77.09)	87(81.31)
未婚/离异或丧偶	41(22.91)	20(18.69)
居住地[例(%)]			2.990^b	0.084
城市	143(79.89)	94(87.85)
农村	36(20.11)	13(12.15)
居住状况[例(%)]			2.325^b	0.127
独居	40(22.35)	16(14.95)
非独居	139(77.65)	91(85.05)
文化程度[例(%)]			6.868^c	0.032
小学及以下	57(31.84)	30(28.04)
初中	73(40.78)	32(29.90)
高中及以上	49(27.38)	45(42.06)
家庭人均月收入[例(%)]			1.676^c	0.432
＜3 000元	44(24.58)	25(23.36)
3 000~6 000元	89(49.72)	47(43.93)
＞6 000元	46(25.70)	35(32.71)
吸烟[例(%)]			6.866^b	0.010
是	63(35.20)	22(20.56)
否	116(64.80)	85(79.44)
饮酒[例(%)]			0.954^b	0.329
是	74(41.34)	38(35.51)
否	105(58.66)	69(64.49)
合并高血压[例(%)]			2.417^b	0.120
是	149(83.24)	81(75.70)
否	30(16.76)	26(24.30)
合并糖尿病[例(%)]			10.698^b	0.001
是	56(31.28)	15(14.02)
否	123(68.72)	92(85.98)
卒中史[例(%)]			4.350^b	0.037
首发	118(65.92)	83(77.57)
复发	61(34.08)	24(22.43)
卒中类型[例(%)]			0.108^b	0.742
出血性	47(26.26)	30(28.04)
缺血性	132(73.74)	77(71.96)
服用药物种类[例(%)]			4.409^b	0.036
≤4种	105(58.66)	76(71.03)
＞4种	74(41.34)	31(28.97)
吞咽功能[例(%)]			3.963^b	0.047
正常	108(60.34)	77(71.96)
障碍	71(39.66)	30(28.04)
身体衰弱[例(%)]			9.986^b	0.002
否	110(61.45)	85(79.44)
是	69(38.55)	22(20.56)
营养不良[例(%)]			11.894^b	0.001
否	142(79.33)	101(94.39)
是	37(20.67)	6(5.61)
抑郁[例(%)]			7.902^b	0.005
否	128(71.51)	92(85.98)
是	51(28.49)	15(14.02)
注：^a为Z值，^b为χ²值，^c为H值。

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表 2 变量赋值情况

Table 2. Variable assignment

变量	赋值方法
OF	无=0，有=1
年龄	以实际值赋值
性别	男性=0，女性=1
文化程度	小学及以下=1，初中=2，高中及以上=3
吸烟	否=0，是=1
合并糖尿病	否=0，是=1
用药种类	≤4种=0，＞4种=1
吞咽功能	正常=0，障碍=1
身体衰弱	否=0，是=1
营养不良	否=0，是=1
抑郁	否=0，是=1

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表 3 老年脑卒中患者OF影响因素的logistic回归分析

Table 3. Logistic regression analysis of influencing factors for oral frailty in elderly stroke patients

项目	B	SE	Waldχ²	P值	OR值	95% CI
常量	10.305	2.631	15.341	< 0.001
年龄	0.474	0.176	7.264	0.008	1.607	1.138~2.268
女性	0.249	0.120	4.305	0.035	1.283	1.014~1.623
吸烟史	0.418	0.179	5.543	0.019	1.519	1.069~2.134
合并糖尿病	1.392	0.367	14.386	< 0.001	4.022	1.960~8.259
身体衰弱	1.134	0.315	12.960	< 0.001	3.108	1.676~5.763
营养不良	1.542	0.381	16.380	< 0.001	4.674	2.215~9.860
抑郁	1.051	0.299	12.356	< 0.001	2.860	1.592~5.140

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