作者：杨旭，刘媛，李倩

单位：

225300江苏省扬州市，扬州大学附属医院全科医学科

Units：

Department of General Practice, Affiliated Hospital of Yangzhou University, Yangzhou 225300, China

关键词：

卒中；中年人；青年人；重返工作岗位；影响因素分析；列线图

Keywords：

Stroke; Middle aged; Young adult; Return to work; Root cause analysis; Nomograms

CLC：

R 743

DOI：

10.12114/j.issn.1008-5971.2024.00.063

Funds：

江苏省医院协会2018年度医院管理创新研究课题（JSYGY-2-2018-59）

摘要：

目的　分析中青年脑卒中患者不能重返工作岗位的影响因素，并构建其风险预测列线图模型。方法 采用便利抽样法选取2021年1月—2023年 3月扬州大学附属医院收治的中青年脑卒中患者 266例为研究对象。根据患 者是否重返工作岗位将其分为复工组（ n=119 ）和非复工组（n=147）。采用自制基线资料调查表收集患者的临床资 料。采用多因素Logistic回归分析探讨中青年脑卒中患者不能重返工作岗位的影响因素；基于多因素Logistic回归分析结 果，采用R 4.0.2软件构建中青年脑卒中患者不能重返工作岗位的风险预测列线图模型；使用ROC曲线评估该列线图模 型的区分度；采用校准曲线及Hosmer-Lemeshow拟合优度检验评估该列线图模型的一致性。结果　多因素Logistic回归 分析结果显示，文化程度为高中及以下、有其他慢性病、工作性质以体力劳动为主、抑郁、脑卒中后神经功能障碍、 家庭支持水平低、脑卒中患者病耻感量表得分升高为中青年脑卒中患者不能重返工作岗位的危险因素，社会支持水 平中等、社会支持水平高、中文版重返工作自我效能问卷（RTW-SE）得分升高为中青年脑卒中患者不能重返工作岗 位的保护因素（P＜0.05）。基于多因素Logistic回归分析结果，构建中青年脑卒中患者不能重返工作岗位的风险预测 列线图模型。ROC曲线分析结果显示，该列线图模型预测中青年脑卒中患者不能重返工作岗位的AUC为0.890〔95%CI （0.851～0.928）〕。校准曲线分析及Hosmer-Lemeshow拟合优度检验结果显示，该列线图模型预测中青年脑卒中患者 不能重返工作岗位的发生率与中青年脑卒中患者不能重返工作岗位的实际发生率相似（χ2 =7.893，P=0.444）。结论 文化程度为高中及以下、有其他慢性病、工作性质以体力劳动为主、抑郁、脑卒中后神经功能障碍、家庭支持水平 低、脑卒中患者病耻感量表得分升高为中青年脑卒中患者不能重返工作岗位的危险因素，社会支持水平中等、社会支 持水平高、中文版RTW-SE得分升高为中青年脑卒中患者不能重返工作岗位的保护因素。本研究基于上述影响因素构 建的中青年脑卒中患者不能重返工作岗位的风险预测列线图模型具有较好的区分度及一致性。

Abstract：

Objective To analyze the influencing factors of failure to return to work in young and middle-aged stroke patients, and construct its risk prediction nomogram model. Methods A total of 266 young and middle-aged stroke patients admitted to Affiliated Hospital of Yangzhou University from January 2021 to March 2023 were selected as the study subjects using convenience sampling method. Patients were divided into return group ( n=119) and non-return group (n=147) according to whether they returned to work or not. The patients' clinical data were collected using self-made baseline data questionnaire. Multivariate Logistic regression analysis was used to explore the influencing factors of failure to return to work in young and middle-aged stroke patients. Based on the results of multivariate Logistic regression analysis, R 4.0.2 software was used to construct the risk prediction nomogram model of failure to return to work in young and middle-aged stroke patients. ROC curve was used to evaluate the differentiation of the nomogram model. Calibration curve and Hosmer-Lemeshow goodness of fit test were used to evaluate the consistency of the nomogram model. Results The results of multivariate Logistic regression analysis showed that education level of high school or below, other chronic diseases, physical labor as the main type of work, depression, post-stroke neurological dysfunction, low family support level, and increased Stroke Stigma Scale score were risk factors for failure to return to work in young and middle-aged stroke patients, moderate level of social support, high level of social support, and increased Chinese version of Return-To-Work Self-Efficacy Questionnaire (RTW-SE) score were protective factors for failure to return to work in young and middle-aged stroke patients (P < 0.05) . Based on the results of multivariate Logistic regression analysis, the risk prediction nomogram model of failure to return to work in young and middle-aged stroke patients were constructed. ROC curve analysis showed that the AUC of the nomogram model in predicting failure to return to work in young and middle-aged stroke patients was 0.890 [95%CI (0.851-0.928) ] . Calibration curve analysis and Hosmer-Lemeshow goodness-of-fit test showed that the incidence of failure to return to work in young and middle-aged stroke patients predicted by the nomogram model was similar to the actual incidence of failure to return to work in young and middle-aged stroke patients ( χ 2 =7.893, P=0.444) . Conclusion Education level of high school or below, other chronic diseases, physical labor as the main type of work, depression, post-stroke neurological dysfunction, low family support level, and increased Stroke Stigma Scale score are risk factors for failure to return to work in young and middle-aged stroke patients, and moderate level of social support, high level of social support, and increased Chinese version of RTW-SE score are protective factors for failure to return to work in young and middle-aged stroke patients. The risk prediction nomogram model of failure to return to work in young and middle-aged stroke patients constructed based on the above influencing factors in this study has good discrimination and consistency.

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