老年脑卒中后咽期吞咽障碍患者营养不良的风险列线图模型构建

胡玲琴; 王小华; 任一理; 王钧

doi:10.16766/j.cnki.issn.1674-4152.003947

老年脑卒中后咽期吞咽障碍患者营养不良的风险列线图模型构建

doi: 10.16766/j.cnki.issn.1674-4152.003947

绍兴文理学院附属医院老年医学科，浙江绍兴 312000

基金项目:

浙江省中医药科技计划项目 2021ZB310

详细信息

通讯作者:
胡玲琴，E-mail：xuriyangguangqq@163.com

中图分类号: R743.3
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- 文章访问数: 4
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出版历程
- 收稿日期: 2024-07-24
- 网络出版日期: 2025-06-30

Construction of a nomogram for predicting malnutrition risk in elderly patients with pharyngeal dysphagia after stroke

Department of Geriatrics, Affiliated Hospital of Shaoxing University, Shaoxing, Zhejiang 312000, China

摘要

摘要: 目的构建适用于老年脑卒中后咽期吞咽障碍患者的营养不良风险筛查的列线图工具，为改善患者营养不良筛查现状提供帮助。方法选取2020年12月—2023年12月就诊于绍兴文理学院附属医院的老年脑卒中后咽期吞咽障碍患者115例，依据微型营养评估法(MNA)评分分为营养不良组(MNA评分＜17分，43例)和非营养不良组(MNA评分≥17分，72例)。比较2组相关资料，采用多因素logistic回归分析筛选发生营养不良的危险因素，应用R软件构建列线图模型并进行模型验证。结果 115例老年脑卒中后咽期吞咽障碍患者中存在营养不良43例，发生率为37.39%。多因素logistic回归分析结果显示，吞咽启动延迟、误吸、年龄校正查尔森合并症指数(aCCI)评分、进食方式、会厌折返障碍均为老年脑卒中后咽期吞咽障碍患者营养不良的独立影响因素(OR＞1，P＜0.05)。基于上述5项指标构建老年脑卒中后咽期吞咽障碍患者的营养不良风险预测模型，验证其ROC曲线下面积为0.959(95% CI：0.904~0.987)。校准曲线斜率相近，经Hosmer-Lemeshow检验χ²=8.254，P=0.628。结论老年脑卒中后咽期吞咽功能障碍患者的营养不良发生率较高，吞咽启动延迟、误吸、aCCI评分、进食方式、会厌折返障碍均会增加患者营养不良的发生风险。本研究建立的列线图预测模型能够为老年脑卒中后咽期吞咽功能障碍患者营养不良的早期预警识别提供帮助。
- 脑卒中 /
- 老年 /
- 咽期 /
- 吞咽障碍 /
- 营养不良 /
- 列线图
Abstract: Objective To construct a nomogram tool for screening malnutrition risk in elderly patients with pharyngeal swallowing disorders after stroke, aiming to improve the accuracy of malnutrition assessment. Methods A total of 115 elderly patients with post-stroke pharyngeal dysphagia disorder admitted to Affiliated Hospital of Shaoxing University from December 2020 to December 2023 were selected and divided into a malnutrition group (MNA score < 17 points, n=43) and a non-malnutrition group (MNA score ≥17 points, n=72) according to the micro-nutrition assessment (MNA) score. Multivariate logistic regression analysis was used to screen the risk factors for malnutrition, and R software component nomogram model was used to verify the model. Results Among the 115 elderly patients with pharyngeal dysphagia after stroke, 43 (37.39%) were diagnosed with malnutrition. Multivariate logistic regression showed delayed swallowing initiation, aspiration, aCCI score, feeding method, and epiglottic reversion disorder as independent risk factors for malnutrition in elderly patients after stroke (OR>1, P < 0.05). Based on the above five indexes, the malnutrition risk prediction model of dysphagia in elderly stroke was constructed, achieving an area under the ROC curve of 0.959 (95% CI: 0.904-0.987). The calibration curve demonstrated good agreement, with a Hosmer-Lemeshow test result of χ²=8.254, P=0.628. Conclusion Elderly patients with laryngeal swallowing dysfunction after stroke have a high incidence of malnutrition. Key risk factors include delayed swallowing initiation, aspiration, aCCI score, feeding method, and epiglottic reentry disorder. The nomogram model established in this study can provide a reliable tool for early warning and identification of malnutrition in elderly patients with laryngeal swallowing dysfunction after stroke.
- Stroke /
- Elderly /
- Retropharyngeal stage /
- Swallowing disorder /
- Malnutrition /
- Nomogram

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图 1 老年脑卒中后咽期吞咽障碍患者营养不良风险的列线图模型

Figure 1. Nomogram model for predicting malnutrition risk in elderly patients with post-stroke pharyngeal dysphagia

下载: 全尺寸图片幻灯片

图 2 列线图预测老年脑卒中后咽期吞咽障碍患者营养不良发生风险的ROC曲线

Figure 2. ROC curve for predicting malnutrition risk in elderly patients with post-stroke pharyngeal dysphagia

下载: 全尺寸图片幻灯片

图 3 列线图预测老年脑卒中后咽期吞咽障碍患者营养不良发生风险的校准曲线

Figure 3. Calibration curve for predicting malnutrition risk in elderly patients with post-stroke pharyngeal dysphagia

下载: 全尺寸图片幻灯片

表 1 2组老年脑卒中后咽期吞咽障碍患者各指标比较

Table 1. Comparison of indexes between two groups of elderly patients with post-stroke pharyngeal dysphagia

项目	营养不良组(n=43)	非营养不良组(n=72)	统计量	P值
性别(例)			1.154^a	0.283
男性	25	49
女性	18	23
年龄(x±s, 岁)	73.51±8.25	69.71±6.94	2.645^b	0.009
BMI(x±s)	21.35±2.54	23.29±2.89	3.640^b	＜0.001
并发症(例)
糖尿病	12	22	0.091^a	0.763
高血压	9	22	1.267^a	0.260
冠心病	8	13	0.005^a	0.941
进食方式(例)			8.585^a	0.014
IOE	26	27
NGT	12	20
经口进食	5	25
饮食习惯(例)			5.058^a	0.080
清淡	18	16
适中	9	22
油腻	16	34
脑卒中类型(例)			0.600^a	0.439
出血性	9	11
缺血性	34	61
咽期吞咽障碍评估结果(例)
吞咽启动延迟	26	24	8.064^a	0.005
会厌折返障碍	21	11	15.097^a	＜0.001
梨状隐窝残留	22	20	6.350^a	0.012
咽后壁残留	15	17	1.703^a	0.192
误吸(例)	30	22	16.711^a	＜0.001
aCCI评分[M(P₂₅, P₇₅), 分]	5(4, 6)	3(2, 4)	6.944^c	＜0.001
NIHSS评分(例)			0.238^c	0.812
0~1分	17	29
2~4分	9	17
≥5分	17	26
衰弱(例)	26	25	7.229^a	0.007
注：^a为χ²值，^b为t值，^c为Z值。IOE为间歇经口至食管管饲(intermittent oroesophageal tube feeding)，NGT为鼻胃管管饲(nasogastric tube feeding)。

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表 2 变量赋值情况

Table 2. Variable assignment

变量	赋值方法
营养不良	是=1，否=0
年龄	连续性变量，以实际值赋值
BMI	连续性变量，以实际值赋值
吞咽启动延迟	是=1，否=0
会厌折返障碍	是=1，否=0
梨状隐窝残留	是=1，否=0
误吸	发生=1，未发生=0
aCCI评分	连续性变量，以实际值赋值
衰弱	是=1，否=0
进食方式	经口进食=0，IOE=1，NGT=2

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表 3 老年脑卒中后咽期吞咽障碍患者营养不良影响因素的logistic回归分析

Table 3. Logistic regression analysis of factors influencing factors malnutrition in elderly patients with post-stroke pharyngeal dysphagia

变量	B	SE	Waldχ²	P值	OR值	95% CI
aCCI评分	2.098	0.487	18.540	< 0.001	8.150	3.136~21.180
会厌折返障碍	1.870	0.822	5.171	0.023	6.489	1.295~32.523
进食方式	1.117	0.471	5.620	0.018	3.054	1.213~7.688
吞咽启动延迟	1.509	0.711	4.501	0.034	4.523	1.122~18.236
误吸	2.198	0.766	8.227	0.004	9.009	2.006~40.463
注：本表仅列出差异有统计学意义的变量。

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