基于列线图模型及系统性发病危险因素预测视网膜静脉阻塞发生风险的研究  

Study on predicting the risk of retinal vein occlusion based on nomogram model and systemic risk factors

作　　者：邵美琳 任梅梅 张文怡 杨卓妍 吴一丹 王建明[1] 王丽君[1] Shao Meilin;Ren Meimei;Zhang Wenyi;Yang Zhuoyan;Wu Yidan;Wang Jianming;Wang Lijun(Department of Ophthalmology,The Second Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710004,China)

机构地区：[1]西安交通大学第二附属医院眼科,西安710004

出　　处：《中华眼底病杂志》2023年第5期381-386,共6页Chinese Journal of Ocular Fundus Diseases

基　　金：陕西省重点研发计划项目(2022SF-154,2023-YBSF-495)。

摘　　要：目的建立并初步验证预测视网膜静脉阻塞(RVO)发生风险的列线图模型。方法回顾性临床研究。2017年1月至2022年4月于西安交通大学第二附属医院眼科检查确诊的RVO患者162例(RVO组)及白内障患者162例(nRVO组)作为建模集;2022年1月至2023年2月于西安市第四医院眼科确诊的视网膜分支静脉阻塞、视网膜中央静脉阻塞、白内障患者各45例作为验证集。RVO组、nRVO组患者间性别构成比(χ^(2)=2.433)、年龄(Z=1.006)比较,差异无统计学意义(P=0.120、0.320)。详细收集患者年龄、性别、血常规(白细胞计数、血红蛋白浓度、血小板计数、中性粒细胞计数、单核细胞计数、淋巴细胞计数、红细胞比容、平均血小板体积、血小板体积分布宽度)、凝血四项(凝血酶原时间测定、活化部分凝血活酶时间测定、纤维蛋白原、凝血酶时间测定)、尿酸、血脂(总胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、脂蛋白a)以及高血压、糖尿病、冠心病、脑梗死病史。计算中性粒细胞/淋巴细胞比值、血小板/淋巴细胞比值。采用单因素logistic回归分析建模集两组患者的临床参数,应用逐步回归法进行变量筛选,构建预测RVO风险的列线图;应用Bootstrap方法重复抽样1000次进行内部、外部验证,分别采用H-L拟合优度检验和受试者工作特征(ROC)曲线评估列线图模型的校准度和区分度。结果单因素logistic回归和逐步回归法分析筛选,高密度脂蛋白、中性粒细胞计数、高血压等3个变量纳人最终预测模型构建列线图。建模集和验证集H-L拟合优度检验的χ^(2)值分别为0.711、4.230,P值分别为0.701、0.121;C-index分别为0.741[95%可信区间(CI)0.688~0.795]、0.741(95%CI0.647~0.835),提示列线图模型具有较好的预测准确度;列线图模型预测建模集和验证集的ROC曲线下面积分别为0.741(95%CI0.688~0.795)、0.741(95%CI0.646~0.836),提示列线图模型具有Objective To establish and preliminarily validate a nomogram model for predicting the risk of retinal vein occlusion(RVO).Methods A retrospective clinical study.A total of 162 patients with RVO(RVO group)diagnosed by ophthalmology examination in The Second Affiliated Hospital of Xi'an Jiaotong University from January 2017 to April 2022 and 162 patients with age-related cataract(nRVO group)were selected as the modeling set.A total of 45 patients with branch RVO,45 patients with central RVO and 45 patients with age-related cataract admitted to Xi'an Fourth Hospital from January 2022 to February 2023 were used as the validation set.There was no significant difference in gender composition ratio(χ^(2)=2.433)and age(Z=1.006)between RVO group and nRVO group(P=0.120,0.320).Age,gender,blood routine(white blood cell count,hemoglobin concentration,platelet count,neutrophil count,monocyte count,lymphocyte count,erythrocyte volume,mean platelet volume,platelet volume distribution width),and four items of thrombin(prothrombin time,activated partial thrombin time,fibrinogen,and thrombin timewere collected in detail),uric acid,blood lipids(total cholesterol,triglyceride,high-density lipoprotein,low-density lipoprotein,lipoprotein a),hypertension,diabetes mellitus,coronary heart disease,and cerebral infarction.Neutrophil/lymphocyte ratio and platelet/lymphocyte ratio were calculated.The single logistic regression was used to analyze the clinical parameters of the two groups of patients in the modeling set,and the stepwise regression method was used to screen the variables,and the column graph for predicting the risk of RVO was constructed.The Bootstrap method was used to repeated sample 1000 times for internal and external verification.The H-L goodness-of-fit test and receiver operating characteristic(ROC)curve were used to evaluate the calibration and discrimination of the nomogram model.Results After univariate logistic regression and stepwise regression analysis,high density lipoprotein,neutrophil count and hypertension were

关 键 词：视网膜静脉阻塞 列线图 风险模型 

分 类 号：R774.1[医药卫生—眼科]