基于倾向性评分匹配法探讨糖尿病视网膜病变术后继发出血的因素  

Factors for postoperative hemorrhage in diabetic retinopathy by propensity score-matched analysis

作　　者：杨娜[1] 张月玲[1] 王丽英[1] 温晓英[1] 付燕[1] YANG Na;ZHANG Yueling;WANG Liying;WEN Xiaoying;FU Yan(Department of Ophthalmology,Baoding First Central Hospital,Baoding 071000,China)

机构地区：[1]保定市第一中心医院眼科,河北保定071000

出　　处：《皖南医学院学报》2023年第5期450-453,共4页Journal of Wannan Medical College

基　　金：河北省医学科学研究课题(20220290)。

摘　　要：目的:基于倾向性评分匹配法探讨糖尿病视网膜病变(DR)术后继发出血的因素。方法:回顾性分析保定市第一中心医院2019年1月~2022年1月收治的513例DR患者的临床资料,根据是否继发出血将其分为出血组和未出血组。利用倾向性评分匹配法对两组患者进行1∶1配对,比较配对前后两组患者的一般资料,采用单因素和多因素Logistic回归分析匹配后DR术后继发出血的危险因素。结果:匹配后两组一般资料比较差异无统计学意义(P>0.05)。出血组DR分期Ⅵ期、术前激光治疗次数>1次、术中剥除视网膜增殖膜占比及糖尿病病程、术前视网膜灌注压、术中收缩压(SBP)、术前空腹血糖(FBG)、术前糖化血红蛋白(HbA1c)水平均高于未出血组(P<0.05),出血组硅油玻璃体腔填充物、术前抗血管内皮生长因子(VEGF)治疗占比低于未出血组(P<0.05);多因素Logistic回归分析结果显示,匹配后糖尿病病程长以及术前视网膜灌注压、术中SBP、术前FBG、术前HbA1c升高、术中剥除视网膜增殖膜均是影响DR患者术后继发出血的危险因素(P<0.05),硅油玻璃体填充物、术前抗VEGF治疗是其保护因素(P<0.05)。结论:经倾向性评分匹配后发现,糖尿病病程长、术前抗VEGF治疗、硅油玻璃体填充物、术中剥除视网膜增殖膜以及术前视网膜灌注压、术前FBG、术前HbA1c、术中SBP升高均是DR患者术后继发出血的影响因素。Objective:To investigate the factors of secondary bleeding after diabetic retinopathy(DR)surgery based on propensity score matching.Methods:The clinical data were retrospectively analyzed in 513 patients with DR admitted to our hospital between January 2019 and January 2022.The patients were divided into bleeding group and non-bleeding group according to presence of secondary hemorrhage.The propensity score matching method was used to match the two groups of patients by ratio of 1:1.The general data were then compared between the two groups before and after matching.Risk factors associated with secondary hemorrhage after DR surgery were identified by univariate and multivariate logistic regression analysis in the propensity matched cohort.Results:There was no significant difference in general data between the two groups after matching(P>0.05).The DR stageⅥ,preoperative laser treatment times(>1),proportion of retinal proliferative membrane intraoperative removal,diabetes course,preoperative retinal perfusion pressure,intraoperative systolic blood pressure(SBP),preoperative fasting blood glucose(FBG)and preoperative Hb A1c levels in the bleeding group were higher than those in the non-bleeding group(P<0.05).The proportion of silicone oil vitreous cavity filler and preoperative anti-vascular endothelial growth factor(VEGF)treatment was lower in the bleeding group than in the non-bleeding group(P<0.05).Multivariate logistic regression analysis showed that risk factors for postoperative secondary hemorrhage in DR patients included long course of diabetes,increase of preoperative retinal perfusion pressure,intraoperative SBP,preoperative FBG and preoperative glycosylated hemoglobin(Hb A1c),and removal of retinal proliferative membrane during operation(P<0.05).Silicone oil vitreous filler and preoperative anti-VEGF treatment were protective factors(P<0.05).Conclusion:Propensity score matching results suggest that long course of diabetes,preoperative anti-VEGF treatment,silicone oil vitreous filler,intraoperative remov

关 键 词：糖尿病视网膜病变 继发出血 倾向性评分匹配法 影响因素 

分 类 号：R587.1[医药卫生—内分泌] R774.1[医药卫生—内科学]