基于竞争风险理论的精神分裂症患者心血管疾病风险评估模型研究

Cardiovascular diseases (CVD) are one of the major causes for early mortality in patients with schizophrenia. However, effective diagnosis and treatment of cardiovascular diseases is rare in schizophrenia patients. The pathogenesis of CVD in schizophrenia patients is not clear. In addition, the lack of appropriate and widely-used risk assessment tools make early prevention and intervention difficult in public health practice. Based on Shandong Whole Population Lifespan Large Database and its derived Schizophrenia Longitudinal Cohort, we aim to 1) clarify mortality risk and cardiovascular disease distribution for schizophrenic patients in Shandong Province. 2) explore risk factors of CVD in schizophrenic patients by using conditional Logistic regression model based on nested case-control design. 3) develop CVD prediction models and its simple and practical software package for schizophrenic patients based on cohort design by using sub-distribution competing risk model and multi-level modeling strategy with random effects introduced. The present study would provide new insight into risk assessment of CVD in schizophrenia patients as well as health management of psychosomatic diseases, and it is of great practical significance for providing individualized prevention, intervention, diagnosis and treatment for patients with schizophrenia.

心血管疾病（Cardiovascular disease, CVD）是精神分裂症患者的主要死因之一，然而，精神分裂症合并CVD并没有得到有效的诊断和治疗。目前对精神分裂症患者CVD发病机制尚不明确，且缺乏适宜的、可广泛应用的发病风险评估工具，因而难以有效开展早期预防和干预。本项目依托“山东省全人群全生命历程健康医疗大数据队列”和“精神分裂症患者纵向监测队列”，拟阐明精神分裂症患者的死亡风险及心血管疾病分布情况；采用巢式病例对照设计，借助条件Logistic回归模型，筛选精神分裂症患者心血管疾病相关危险因素；采用前瞻性队列设计，基于竞争风险理论和多水平建模策略，构建精神分裂症患者CVD适宜风险评估模型，并编制简单实用的软件包。本项目将为精神障碍患者CVD风险评估及心身疾病健康管理提供思路和方法，对于精神分裂症患者合理选择个性化预防、干预、诊断及治疗方案具有重要的实际意义。

心血管疾病（Cardiovascular disease, CVD）是精神分裂症患者的主要死因之一，然而，精神分裂症合并CVD并没有得到有效的诊断和治疗。针对一般人群构建的CVD风险评估模型并不适用于精神分裂症患者的CVD风险评估。因此，需要基于精神分裂症患者这一特殊人群构建CVD风险评估模型进而制定适宜的健康管理策略。本研究依托“山东省全人群全生命历程健康医疗大数据队列”平台和“精神分裂症患者纵向监测子队列”，首先，分析了精神分裂症患者CVD患病情况，并基于巢式病例对照研究设计，构建了条件Logistic回归模型，筛选出了精神分裂症患者CVD相关危险因素集；然后，基于竞争风险理论和部分分布风险模型，构建了精神分裂症患者CVD风险评估模型；同时，课题组进一步探讨了抗精神病药物使用及不同用药方式、用药剂量与CVD之间的关联，为精神分裂症患者合理用药提供了借鉴。本项目研究结果可为临床提供适宜的、可推广应用的精神分裂症患者CVD风险评估工具，为精神障碍患者CVD风险评估及心身疾病健康管理提供了思路和方法。