基于危险因素评估白内障患者术后角膜水肿发生风险的预测模型构建与验证  

Construction and Validation of a Predictive Model for Assessing the Risk of Postoperative Corneal Edema in Cataract Patients Based on Risk Factors

作　　者：詹丽园[1] 吴宝凤[2] 李秀明[2] 危慧琳[2] 毛姗 ZHAN Liyuan;WU Baofeng;LI Xiuming(Department of Outpatient Ophthalmology,the 907th Hospital of the Joint Logistics Support Force of the People’s Liberation Army of China,Nanping City,Fujian Province 353000;不详)

机构地区：[1]中国人民解放军联勤保障部队第九〇七医院门诊眼科,福建省南平市353000 [2]中国人民解放军联勤保障部队第九〇七医院五官科,福建省南平市353000

出　　处：《医学理论与实践》2024年第14期2363-2366,共4页The Journal of Medical Theory and Practice

摘　　要：目的:构建基于危险因素评估白内障患者术后角膜水肿发生风险的预测模型并验证。方法:选取2021年7月—2023年7月本院收治的339例白内障患者(339眼),将入选者以7∶3比例(按随机数字表法)随机分为建模组(237例)与验证组(102例),根据术后是否发生角膜水肿将患者分为角膜水肿组和非角膜水肿组;构建列线图模型(R软件),评估模型预测效能。结果:本研究237例患者中有68例在术后发生角膜水肿,发生率为28.69%。角膜水肿组和非角膜水肿组在年龄、糖尿病史、晶状体核硬度、手术切口靠前、术前前房深度、后弹力层撕脱方面比较有统计学差异(P<0.05)。多因素Logistic回归分析结果显示,年龄、糖尿病史、晶状体核硬度、手术切口靠前、术前前房深度和后弹力层撕脱是白内障患者术后发生角膜水肿的危险因素(P<0.05)。建模组ROC曲线下面积(AUC)为0.950,区分度较好,H-L检验为χ^(2)=7.364,P=0.681,一致性良好。外部验证的AUC为0.966,区分度较好,H-L检验为χ^(2)=7.517,P=0.702,一致性良好。结论:年龄、糖尿病史、晶状体核硬度、手术切口靠前、术前前房深度和后弹力层撕脱是白内障患者术后发生角膜水肿的危险因素,构建的列线图模型区分度与一致性良好,能直观预测白内障患者术后发生角膜水肿的风险。Objective:To construct a predictive model based on risk factors for evaluating the risk of postoperative corneal edema in cataract patients and validate it.Methods:A total of 339 cataract patients(339 eyes)accepted by our hospital from July 2021 to July 2023 were collected.The selected patients were randomly separated into a modeling group(237 cases)and a validation group(102 cases)in a 7∶3 ratio(using a random number table method).Patients were grouped into corneal edema group and non corneal edema group based on whether corneal edema occurred after surgery;the column chart model(R software)was constructed,and the predictive performance of the model was evaluated.Results:Out of 237 patients in this study,68 developed corneal edema after surgery,with an incidence rate of 28.69%.There were statistical differences between the corneal edema group and the non corneal edema group in age,history of diabetes,hardness of lens nucleus,anterior incision,depth of anterior chamber before surgery,and posterior elastic layer avulsion(P<0.05).Multivariate Logistic regression analysis showed that age,history of diabetes,hardness of lens nucleus,anterior incision,anterior chamber depth and posterior elastic layer avulsion were the risk factors for corneal edema in patients with internal barrier(P<0.05).Area under the ROC curve(AUC)of the modeling group was 0.950,with good discrimination,the H-L test showed χ^(2)=7.364,P=0.681,with good consistency.The AUC for external validation was 0.966,with good discrimination,the H-L test showed χ^(2)=7.517,P=0.702,indicating good consistency.Conclusion:Age,history of diabetes,hardness of lens nucleus,anterior incision,preoperative anterior chamber depth and posterior elastic layer avulsion are the risk factors for corneal edema in cataract patients after surgery.The column chart model constructed has good differentiation and consistency,and can directly predict the risk of corneal edema in cataract patients after surgery.

关 键 词：白内障 角膜水肿 列线图 影响因素 

分 类 号：R776.1[医药卫生—眼科]