甲状腺癌患者癌症相关性认知功能障碍现状调查及影响因素多元回归分析-现代医学

甲状腺癌患者癌症相关性认知功能障碍现状调查及影响因素多元回归分析

单位：南京市中心医院外科, 江苏南京 210000

分类号：R736.1

出版年·卷·期（页码）：2026·54·第三期（436-443）

摘要：

目的：调查甲状腺癌患者癌症相关性认知功能障碍(CRCI)的发生现状，分析其影响因素，并构建回归预测模型。方法：选取2022年5月至2025年4月医院收治的228例甲状腺癌患者为研究对象，采用一般资料调查表、蒙特利尔认知评估量表(MoCA)、营养风险筛查2002(NRS 2002)、匹兹堡睡眠质量指数(PSQI)和抑郁自评量表(SDS)进行评估。依据是否发生CRCI，将患者分为CRCI组与非CRCI组。比较两组患者临床资料，通过Logistic回归分析甲状腺癌患者发生CRCI的独立影响因素，构建回归预测模型，并采用受试者操作特征(ROC)曲线评价模型预测能力；采用Bootstrap法对模型进行内部验证；以Hosmer-Lemeshow(H-L)拟合优度检验及校准曲线评价模型校准度。结果：228例甲状腺癌患者CRCI发生率为52.63%(120/228)。相较于非CRCI组，CRCI组年龄更大，文化程度初中及以下、合并心血管疾病、癌症分期Ⅲ～Ⅳ期、有营养风险、睡眠障碍及抑郁症状占比较高，血清白蛋白水平更低(均P＜0.05)。Logistic回归分析显示，高龄、合并心血管疾病、癌症分期Ⅲ～Ⅳ期、有营养风险、存在睡眠障碍及抑郁症状是甲状腺癌患者发生CRCI的独立影响因素(P＜0.05)。基于相关因素构建的回归预测模型预测甲状腺癌患者发生CRCI的ROC曲线下面积(AUC)为0.920(95%CI 0.883～0.956)，经Bootstrap法重复抽样1 000次内部验证显示C指数为0.918。H-L检验结果显示， χ²=3.059、P=0.931，校准曲线显示预测概率与实际概率高度吻合，提示模型预测一致性良好。结论：甲状腺癌患者CRCI发生率较高，高龄、合并心血管疾病、癌症分期Ⅲ～Ⅳ期、有营养风险、有睡眠障碍及抑郁症状均是其独立危险因素，据此构建的回归预测模型具有良好的预测效能，可为临床早期识别高危患者并实施针对性干预策略提供科学依据。

Objective: To investigate the prevalence status of cancer-related cognitive impairment(CRCI) in patients with thyroid cancer, analyze its influencing factors, and construct a regression prediction model. Methods: A total of 228 patients with thyroid cancer admitted to the hospital from May 2022 to April 2025 were selected as study subjects. The General Information Questionnaire, Montreal Cognitive Assessment(MoCA), Nutritional Risk Screening 2002(NRS 2002), Pittsburgh Sleep Quality Index(PSQI), and Self-Rating Depression Scale(SDS) were used for the investigation. Patients were divided into a CRCI group and a non-CRCI group based on the presence of CRCI. Clinical data were compared between the two groups. Logistic regression was used to analyze the independent associated factors for the occurrence of CRCI in thyroid cancer patients, and a regression prediction model was constructed. The predictive ability of the model was evaluated using the receiver operating characteristic(ROC) curve. Internal validation of the model was performed using the Bootstrap method. The calibration of the model was evaluated using the Hosmer-Lemeshow(H-L) goodness-of-fit test and calibration curve.Results: The incidence of CRCI in the 228 patients with thyroid cancer was 52.63%(120/228). Compared with the non-CRCI group, the CRCI group had significantly higher proportions of advanced age, education level of junior high school or below, comorbidity of cardiovascular disease, cancer stage Ⅲ-Ⅳ, nutritional risk, sleep disorders, and depressive symptoms, as well as lower serum albumin levels(P<0.05). Logistic regression analysis showed that advanced age, comorbidity of cardiovascular disease, cancer stage Ⅲ-Ⅳ, nutritional risk, sleep disorders, and depressive symptoms were independently associated with the occurrence of CRCI in patients with thyroid cancer(P<0.05). The area under the ROC curve(AUC) of the regression prediction model constructed based on associated factors for predicting CRCI was 0.920(95% CI 0.883-0.956). Internal validation using 1 000 bootstrap resamples showed a C-index of 0.918. The H-L test results showed χ²=3.059, P=0.931. The calibration curve showedthat the predicted probability was highly consistent with the actual probability, suggesting good consistency of the model prediction. Conclusion: The incidence of CRCI in patients with thyroid cancer is relatively high. Advanced age, comorbidity of cardiovascular disease, cancer stage Ⅲ-Ⅳ, nutritional risk, sleep disorders, and depressive symptoms are all independently associated with the occurrence of CRCI. The regression prediction model constructed based on these factors demonstrates good predictive performance, providing a scientific basis for early clinical identification of high-risk patients and the implementation of targeted intervention strategies.

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