甲状腺癌患者术后新发抑郁的影响因素及风险列线图预测模型的构建OA
Factors associated with postoperative new-onset depression in patients with thyroid cancer and construction of a risk nomogram prediction model
目的 分析甲状腺癌患者新发抑郁的影响因素并构建列线图模型.方法 选取2023年2月至2024年12月287例甲状腺癌患者,根据其术后是否新发抑郁分为非抑郁组(n=216)、新发抑郁组(n=71),收集患者资料,采用多因素logistic分析甲状腺癌患者新发抑郁的影响因素,并建立列线图预测模型,采用受试者工作特征(ROC)曲线和校准曲线对模型进行验证.结果 单因素显示,手术对身体形象的改变、家庭人均月收入、肿瘤复发风险、131I治疗、有无其他慢性疾病、家庭功能、心理韧性、社会支持与甲状腺癌患者新发抑郁相关(P均＜0.05);多因素logistic分析显示:家庭人均月收入(OR=0.994,95％CI:0.992～0.996)、131I 治疗(OR=3.479,95％CI:1.088～11.122)、家庭功能(OR=0.976,95％CI:0.953～0.999)、心理韧性(OR=0.836,95％CI:0.770～0.907)、社会支持(OR=0.858,95％CI:0.764～0.964)是甲状腺癌患者新发抑郁(P均＜0.05);建立列线图模型方程:Log(P)=-0.006 ×家庭人均月收入+1.247 × 131I治疗-0.024 ×家庭功能-0.179 ×心理韧性-0.153 ×社会支持+40.392的ROC曲线下AUC为0.842(0.782～0.902);Bootstrap法进行内部验证显示预测曲线与标准模型曲线拟合度较高.结论 家庭人均月收入低、131I治疗、家庭功能低、心理韧性低、社会支持低均是甲状腺癌患者新发抑郁的危险因素,基于上述因素构建的列线图模型具有一定效能.
Objective To identify factors associated with postoperative new-onset depression in patients with thyroid cancer and to develop a nomogram-based risk prediction model.Methods A total of 287 patients with thyroid cancer treated between February 2023 and December 2024 were enrolled.According to the presence of new-onset depres-sion after surgery,patients were divided into a non-depression group(ni=216)and a new-onset depression group(n=71).Demographic,clinical,and psychosocial data were collected.Multivariate logistic regression analysis was performed to identify independent predictors of postoperative new-onset depression,and a nomogram prediction model was estab-lished.Model performance was evaluated using the receiver operating characteristic(ROC)curve and calibration curve.Results Univariate analysis showed that postoperative changes in body image,monthly per capita household income,tumor recurrence risk,131I therapy,presence of other chronic diseases,family function,psychological resilience,and so-cial support were significantly associated with new-onset depression(all P＜0.05).Multivariate logistic regression anal-ysis identified monthly per capita household income(OR=0.994,95％CI:0.992-0.996),131I therapy(OR=3.479,95％CI:1.088-11.122),family function(OR=0.976,95％CI:0.953-0.999),psychological resilience(OR=0.836,95％CI:0.770-0.907),and social support(OR=0.858,95％CI:0.764-0.964)as independent predictors of postoperative new-onset depression(all P＜0.05).The nomogram model equation was:Log(P)=-0.006 × monthly per capita household income+1.247 × 131I therapy-0.024 × family function-0.179 × psychological resili-ence-0.153 × social support+40.392.The area under the ROC curve(AUC)was 0.842(95％CI:0.782-0.902).Internal validation using the bootstrap method demonstrated good calibration and discrimination.Conclusion Low monthly per capita household income,receipt of 131I therapy,poor family function,low psychological resilience,and low social support are significant risk factors for postoperative new-onset depression in patients with thyroid cancer.The nomogram based on these variables shows good predictive performance and may facilitate early identification and targeted psychological intervention.
阮艳红;陈旦旦;倪蓓君;张晚秋
中国科学院合肥肿瘤医院手术中心(安徽 合肥 230088)中国科学院合肥肿瘤医院护理部(安徽 合肥 230088)中国科学院合肥肿瘤医院护理部(安徽 合肥 230088)中国科学院合肥肿瘤医院护理部(安徽 合肥 230088)
医药卫生
甲状腺癌抑郁列线图
thyroid cancerdepressionnomogram
《广东医学》 2026 (2)
172-178,7
安徽省卫生健康科研项目(AHWJ2024Ab0121),中国科学院合肥肿瘤医院管理学部软课题(GLXB202305)
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