摘要
目的 分析糖尿病性黄斑水肿(DME)患者康柏西普治疗后复发的危险因素并构建其风险预测模型,以期为临床决策的制定提供参考。方法 选取2021年1月—2023年12月在本院接受康柏西普治疗的164例DME患者作为研究对象。治疗后连续随访12个月,根据是否复发将患者分为复发组(n=49)和未复发组(n=115)。采用多因素logistic逐步回归分析探讨DME患者康柏西普治疗后复发的影响因素,并构建列线图模型,评估模型对DME患者康柏西普治疗后复发的预测价值。结果 复发组患者年龄≥60岁、有视网膜高反射灶、有视网膜内层结构紊乱(DRIL)所占比例及治疗前黄斑中心凹视网膜厚度(CRT)均大于未复发组,糖尿病病程、DME病程长于未复发组,空腹血糖、糖化血红蛋白水平高于未复发组(P<0.05)。多因素分析显示,年龄≥60岁(OR=1.968,95%CI:1.416~2.735)、DME病程长(OR=2.465,95%CI:1.656~3.669)、治疗前CRT大(OR=2.335,95%CI:1.584~3.442)、有视网膜高反射灶(OR=2.492,95%CI:1.671~3.717)、有DRIL(OR=3.016,95%CI:1.937~4.697)是DME患者康柏西普治疗后复发的危险因素(P<0.05)。根据回归分析结果构建的列线图模型一致性指数(C-index)为0.897(95%CI:0.845~0.949);内部验证分析显示,该列线图模型具有良好的拟合效果(χ^(2)=0.842,P=0.476),且原始曲线接近于理想曲线。列线图模型预测DME患者康柏西普治疗后复发的曲线下面积(AUC)为0.905(95%CI:0.853~0.957),特异度为68.51%,灵敏度为92.74%。结论 年龄、DME病程、治疗前CRT、视网膜高反射灶、DRIL情况是DME患者康柏西普治疗后复发的影响因素,据此构建的列线图模型预测效能较好。
Objective To analyze risk factors for recurrence after Conbercept treatment in patients with diabetic macular edema(DME)and to construct a risk prediction model to inform clinical decision-making.Methods From January 2021 to December 2023,164 DME patients treated with Conbercept at our hospital were included and followed continuously for 12 months after treatment.Patients were grouped by recurrence status into a recurrence group(n=49)and a non-recurrence group(n=115).Multivariable stepwise logistic regression analysis was used to identify factors associated with recurrence after Conbercept,and a nomogram was constructed based on the regression results.The model's predictive value was evaluated for recurrence after Conbercept treatment in patients with DME.Results Compared with the non-recurrence group,the recurrence group had significantly higher proportions of patients aged≥60 years,retinal hyperreflective foci,and disorganization of the retinal inner layers(DRIL),and had greater pre-treatment foveal central retinal thickness(CRT);additionally,the recurrence group had longer durations of diabetes and DME,and higher fasting blood glucose and glycosylated hemoglobin levels(P<0.05).Multivariable analysis identified age≥60 years(OR=1.968,95%CI:1.416-2.735),longer DME duration(OR=2.465,95%CI:1.656-3.669),higher pre-treatment CRT(OR=2.335,95%CI:1.584-3.442),presence of retinal hyperreflective foci(OR=2.492,95%CI:1.671-3.717),and presence of DRIL(OR=3.016,95%CI:1.937-4.697)as risk factors for recurrence after Conbercept treatment(P<0.05).The nomogram based on these variables showed a concordance index(C-index)of 0.897(95%CI:0.845-0.949).Internal validation indicated good model fit(χ^(2)=0.842,P=0.476)and calibration with the calibration curve close to the ideal.The nomogram model predicted an area under the curve(AUC)of 0.905(95%CI:0.853-0.957)for recurrence after Conbercept treatment in DME patients,with a specificity of 68.51%and a sensitivity of 92.74%.Conclusion Age,DME duration,pre-treatment CRT,retinal hyperreflective foci,and DRIL are associated with recurrence after Conbercept treatment in DME patients.The nomogram constructed from these factors demonstrates good predictive performance.
作者
陈凤玲
赖裕旋
李婉嫦
梁桂梅
莫燕霞
陈凤先
陈晓兰
刘惠儿
刘嘉慧
朱玉珍
Chen Fengling;Lai Yuxuan;Li Wanchang;Liang Guimei;Mo Yanxia;Chen Fengxian;Chen Xiaolan;Liu Huier;Liu Jiahui;Zhu Yuzhen(Department of Ophthalmology,The Tenth Affiliated Hospital of Southern Medical University/Dongguan People's Hospital,Dongguan Guangdong 523000,China)
出处
《保健医学研究与实践》
2025年第8期77-83,共7页
Health Medicine Research and Practice
基金
广东省自然科学基金面上项目(2023A1515012454)
广东省东莞市社会发展科技项目(20231800904792)。
