2型糖尿病患者白内障术后干眼的风险模型构建  

Construction of risk model of dry eye after cataract surgery in type 2 diabetic patients

作　　者：鲜依鲆[1] 周杨琳 姚曼[1] Yi-Ping Xian;Yang-Lin Zhou;Man Yao(Department of Ophthalmology,Chengdu First People's Hospital, Chengdu 610000, Sichuan Province, China)

机构地区：[1]中国四川省成都市第一人民医院眼科,610000

出　　处：《国际眼科杂志》2022年第4期623-628,共6页International Eye Science

摘　　要：目的:探究影响2型糖尿病患者白内障术后并发干眼的危险因素,并构建风险预测模型。方法:选择2019-04/2021-04我院收治的合并2型糖尿病的白内障手术患者212例212眼作为研究对象,根据术后并发干眼情况将患者分为干眼组(43例43眼)和无干眼组(169例169眼),比较两组患者的一般资料、术后1wk实验室检查指标、生活质量评分情况;采用多因素Logistic回归分析影响术后并发干眼的危险因素;构建列线图预测模型并评价其预测准确性。结果:两组患者角结膜疾病史、翼状胬肉、睑板腺功能障碍、晶状体核硬度、疾病认知水平、术后焦虑、术后抑郁、手术切口、用药依从性、术后1wk血清白细胞介素-1β(IL-1β)、白细胞介素-6(IL-6)、肿瘤坏死因子-α(TNF-α)、糖化血红蛋白(HbA1c)水平均有差异(P<0.05);多因素Logistic回归分析结果显示,术后焦虑、术后抑郁、手术切口为3.0mm、术后1wk IL-1β>31.26ng/mL、IL-6>29.42ng/mL、TNF-α>77.68ng/mL、HbA1c≥6.50%均是导致患者术后并发干眼的危险因素(P<0.05);列线图预测模型的校准曲线和标准曲线拟合度良好,预测概率大多分布在0和1附近,准确性较高;干眼组患者的视功能评价、环境触发因素、眼部不适症状、眼表疾病指数(OSDI)总评分均明显高于无干眼组(P<0.05)。结论:手术切口、术后焦虑、抑郁、用药依从性、血清炎症因子及HbA1c水平均与2型糖尿病患者白内障术后并发干眼有关,早期识别危险因素并及时进行干预,有利于降低术后干眼发生率,提高患者生活质量。AIM:To explore the risk factors of xerophthalmia after cataract surgery in patients with type 2 diabetes mellitus,and to construct a risk prediction model.METHODS:A total of 212 patients(212 eyes)with type 2 diabetes who underwent cataract surgery in our hospital from April 2019 to April 2021 were selected.The patients were divided into dry eye group(43 cases,43 eyes)and non-xerophthalmia eye(169 cases,169 eyes).The general data,laboratory examination index and quality of life score of the two groups were compared;multivariate Logistic regression analysis was used to analyze the risk factors of postoperative xerophthalmia;constructed a line chart prediction model and evaluated its prediction accuracy.RESULTS:There were significant differences in the history of keratoconjunctival disease,pterygium,meibomian gland dysfunction,lens nucleus hardness,disease cognition,postoperative anxiety,postoperative depression,surgical incision,medication compliance,and the levels of interleukin-1β(IL-1β),interleukin-6(IL-6),tumor necrosis factor-α(TNF-α)and HbA1c at 1wk after operation between the two groups(P<0.05).The results of multivariate Logistic regression analysis showed that postoperative anxiety,postoperative depression,3.0mm of surgical incision,IL-1β>31.26ng/mL,IL-6>29.42ng/mL,TNF-α>77.68ng/mL and HbA1c≥6.50%were risk factors for postoperative xerophthalmia(P<0.05).The calibration curve and standard curve of the nomogram prediction model were fit well,and the prediction probabilities were mostly distributed around 0 and 1,with high accuracy.The visual function evaluation,environmental trigger factors,ocular discomfort symptoms and ocular surface disease index(OSDI)score in the dry eye group was significantly higher than those in the non-xerophthalmia group(P<0.05).CONCLUSION:Surgical incision,postoperative anxiety,depression,medication compliance,serum inflammatory factors and HbA1c are all related to xerophthalmia after cataract surgery in patients with type 2 diabetes.Early identification of risk factors and

关 键 词：2型糖尿病 白内障 干眼 危险因素 列线图预测模型 

分 类 号：R47[医药卫生—护理学]