Page 102 - 南京医科大学自然版

南京医科大学学报（自然科学版） 第45卷第12期
·1784 · Journal of Nanjing Medical University（Natural Sciences） 2025年12月

·临床研究·

老年糖尿病合并认知衰弱患者发生营养不良风险预测模型的

构建

邹 蓉，俞沛文，谈 萍，胡译方，丁国宪，佟蔷薇 *

南京医科大学第一附属医院老年内分泌科，江苏 南京 210029

［摘 要］ 目的：深入剖析影响老年糖尿病合并认知衰弱（cognitive frailty，CF）患者发生营养不良风险的关键因素，并据此构
建风险预测列线图模型。方法：采用横断面研究设计，收集124例老年糖尿病合并CF患者资料，评估患者衰弱、认知功能、心
理状态及营养不良风险。采用多因素Logistic回归分析营养不良的影响因素，采用R语言构建预测模型，绘制列线图。模型验
证采用受试者工作特征曲线分析、Hosmer⁃Lemeshow 检验和一致性指数评估，以及校准曲线绘制。结果：124例老年糖尿病合
并 CF 患者营养不良风险率为 67.7%（84/124），将其纳入营养不良组，其余为营养良好组。年龄、婚姻状况、体重指数（body
mass index，BMI）、老年抑郁评估量表（geriatric depression scale，GDS）评估、白蛋白及前白蛋白水平是老年糖尿病合并CF患者
发生营养不良风险的独立预测因素（P < 0.05）。基于影响因素构建的列线图模型的一致性指数为0.781（95%CI：0.695~0.867），
Hosmer⁃Lemeshow检验显示该列线图模型的拟合效果良好。决策曲线分析表明，当阈值概率为0.10~0.67时，该列线图模型预
测老年糖尿病合并 CF 患者发生营养不良风险的净收益为 0.46~0.60。结论：老年糖尿病合并 CF 患者，年龄、婚姻状况、BMI、
GDS评估、白蛋白和前白蛋白水平是影响营养状况的关键因素。建立的风险预测模型对评估这类患者发生营养不良风险具有
中等的预测效能和良好的临床应用价值。
［关键词］ 老年糖尿病；认知衰弱；营养不良；风险预测模型
［中图分类号］ R587.1 ［文献标志码］ A ［文章编号］ 1007⁃4368（2025）12⁃1784⁃09
doi：10.7655/NYDXBNSN250659

Construction of a risk prediction model for malnutrition in elderly diabetic patients with
cognitive frailty

ZOU Rong，YU Peiwen，TAN Ping，HU Yifang，DING Guoxian，TONG Qiangwei *
Department of Geriatric Endocrinology，the First Affiliated Hospital of Nanjing Medical University，Nanjing 210029，
China

［Abstract］ Objective：To conduct an in⁃depth analysis of the key factors influe⁃ncing the risk of malnutrition in elderly diabetic
patients with cognitive frailty（CF）and to construct an accurate risk prediction nomogram model based on these factors. Methods：A
cross⁃sectional study design was adopted，enrolling 124 elderly diabetic patients with CF. The patients’frailty，cognitive function，
psychological state and risk of malnutrition were evaluated. Multivariate logistic regression analysis was used to identify influencing
factors for malnutrition risk，and the R language was used to construct the prediction model and draw the nomogram. Model validation
was carried out by receiver operating characteristic curve analysis，Hosmer ⁃ Lemeshow test and concordance index evaluation，and
calibration curve drawing. Results：The malnut⁃rition risk rate among the 124 elderly diabetic patients with CF was 67.7%（84/124）.
These 84 patients were assigned to the malnutrition risk group，and the remaining 40 were assigned to the well⁃nourished group. Age，
marital status，body mass index（BMI），geriatric depression scale（GDS）score，albumin，and prealbumin levels were identified as
independent predictors of malnutrition risk in elderly diabetic patients with CF（all P < 0.05）. The nomogram model constructed based
on these influencing factors had a C⁃index of 0.781（95% CI：0.695-0.867）. The Hosmer⁃Lemeshow test indicated a good fit for the
nomogram model. Decision curve analysis showed that when the threshold probability ranged from 0.10 to 0.67，the net benefit rate of

［基金项目］ 江苏省卫生健康委员会科研课题（BJ17015）；中国老年学和老年医学学会科研课题（CAGG2025104）
通信作者（Corresponding author），E⁃mail：qiangwei_tong@163.com（ORCID：0000⁃0003⁃2790⁃4555）
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