杨学智,陆冰,魏菀,曾真,胡思贵,曹永康,马贞玉.酒精使用障碍严重程度的影响因素及风险预测模型构建[J].四川精神卫生杂志,2024,37(2):131-136.Yang Xuezhi,Lu Bing,Wei Wan,Zeng Zhen,Hu Sigui,Cao Yongkang,Ma Zhenyu,Factors influencing the severity of alcohol use disorder and the construction of risk prediction model[J].SICHUAN MENTAL HEALTH,2024,37(2):131-136

酒精使用障碍严重程度的影响因素及风险预测模型构建

Factors influencing the severity of alcohol use disorder and the construction of risk prediction model

投稿时间：2023-10-11

DOI：10.11886/scjsws20231011003

中文关键词: 酒精使用障碍疾病严重程度临床特征 γ-谷氨酰胺转移酶总胆红素

英文关键词:Alcohol use disorder Disease severity diagnostic trait γ-Glutamyl transpeptidase Total bilirubin

基金项目:

作者	单位	邮编
杨学智	广西医科大学公共卫生学院，广西南宁 530021 南宁市第五人民医院，广西南宁 530001	530001
陆冰	南宁市第五人民医院，广西南宁 530001	530001
魏菀	南宁市第五人民医院，广西南宁 530001	530001
曾真	南宁市第五人民医院，广西南宁 530001	530001
胡思贵	南宁市第五人民医院，广西南宁 530001	530001
曹永康	南宁市第五人民医院，广西南宁 530001	530001
马贞玉^*	广西医科大学公共卫生学院，广西南宁 530021	530021

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中文摘要:

背景酒精使用障碍（AUD）是常见的慢性复发性精神疾病，对于重度AUD，需早期快速识别并及时妥善处理，以避免不可逆的伤害发生。目前，对AUD严重程度的评估主要基于临床医师对患者的精神检查，关于AUD严重程度影响因素及预测模型的研究有限。目的分析AUD患者疾病严重程度的影响因素，构建风险预测模型，为评估AUD患者的疾病严重程度提供参考。方法回顾性选取2017年1月1日—2022年12月31日南宁市第五人民医院收治的、符合《精神障碍诊断与统计手册（第5版）》（DSM-5）AUD诊断标准的1 358例首次住院患者为研究对象，收集其基本资料，根据疾病严重程度分为轻中度组（n=330）和重度组（n=1 028）。按7∶3将患者分为训练集和测试集，在训练集样本中构建Logistic回归模型，在测试集样本中采用受试者工作特征（ROC）曲线分析该模型对AUD严重程度的预测价值。结果与轻中度组相比，重度组居住地在城市（χ²=7.804）、农民（χ²=17.991）、饮酒频率高于1~2次/天（χ²=35.267）的比例更高，初次饮酒年龄更大（t=-3.858），合并躯体疾病数量更多（Z=-22.782），γ-谷氨酰胺转移酶（χ²=259.940）和总胆红素异常（χ²=148.552）的比例更高（P均<0.01）。在训练集中进行的Logistic分析结果表明，农民（OR=2.024，95% CI：1.352~3.029）、初次饮酒年龄较大（OR=1.075，95% CI：1.025~1.129）、用餐时间外也饮酒（OR=3.988，95% CI：2.408~6.606）、总胆红素水平异常（OR=1.034，95% CI：1.000~1.069）、合并更多的躯体疾病（OR=4.386，95% CI：2.636~7.298）是AUD更严重的危险因素。该模型在测试集中的ROC曲线下面积（AUC）为0.906。结论在精神专科医院中，农民、初次饮酒年龄较大、用餐时间外也饮酒、总胆红素水平异常、合并更多的躯体疾病可能是重度AUD的危险因素。

英文摘要:

Background Alcohol use disorder （AUD） is a common chronic and relapsing psychiatric disorders. Identifying severe AUD early and intervening promptly is crucial to prevent irreversible harm. Currently， the assessment of AUD severity primarily relies on psychiatric examination by clinicians， and there is limited research on the factors influencing AUD severity and the development of prediction models.Objective To analyze the factors influencing AUD severity， and construct a risk prediction model to aid in the assessment of disease progression in AUD patients.Methods A retrospective analysis was conducted on 1 358 first-time hospitalized patients admitted to Nanning Fifth People's Hospital from January 1， 2017 to December 31， 2022. These patients met the Diagnostic and Statistical Manual of Mental Disorders， fifth edition （DSM-5） criteria for AUD. Basic patient data was collected， and the patients were divided into two groups based on disease severity： mild-moderate group （n=330） and severe group （n=1 028）. The patients were randomly divided into training and test sets in a 7∶3 ratio. A Logistic regression model was constructed in the training set， and the predictive ability of the model for disease severity was evaluated using the receiver operating characteristic （ROC） curve in the test set.Results Compared with the mild-moderate group， the severe group had a higher proportion of patients living in urban areas （χ²=7.804）， were farmers （χ²=17.991）， had a higher frequency of alcohol consumption （more than 1 to 2 drinks/day）（χ²=35.267）， had a higher age at first drinking （t=-3.858）， had a greater number of comorbid somatic disorders （Z=-22.782）， and had higher proportions of γ-Glutamyl transpeptidase （χ²=259.940） and total bilirubin abnormalities （χ²=148.552）（P<0.01）. Logistic analysis conducted in the training set showed that being a farmer （OR=2.024， 95% CI： 1.352~3.029）， having an older age at first drinking （OR=1.075， 95% CI： 1.025~1.129）， drinking outside of mealtimes （OR=3.988， 95% CI： 2.408~6.606）， having total bilirubin abnormalities （OR=1.034， 95% CI： 1.000~1.069）， and having more comorbid somatic diseases （OR=4.386， 95% CI： 2.636~7.298） were identified as risk factors for disease severity in AUD patients. The area under curve （AUC） for this model in the test set was 0.906.Conclusion In psychiatric hospitals， being a farmer， having an older age at first drinking， drinking outside of mealtimes， having abnormal total bilirubin levels， and having comorbidities with somatic illnesses may be risk factors for severe AUD.

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