增生性糖尿病视网膜病变术后再出血风险的预测模型分析OA
Analysis of a predictive model for the risk of postoperative rebleeding in proliferative diabetic retinopathy
目的 分析影响增生性糖尿病视网膜病变(PDR)术后再出血的危险因素,并构建预测模型.方法 回顾性分析2021年6月至2024年12月该院收治的334例PDR患者临床资料,均行标准化25 G玻璃体切割术(PPV),术后随访6个月,期间发生玻璃体再出血(PVH)者60例.经logistic多因素分析明确影响PDR患者PPV后发生PVH的危险因素,并构建预测模型.结果 PVH 组患者术后3、6个月时最佳矫正视力,以及PDR Ⅵ期、术前未玻璃体腔注药、合并增生视网膜牵引患者占比及糖尿病病程、术前糖化血红蛋白(HbA1c)、术后眼压均高于非 PVH 组,差异均有统计学意义(P<0.05).糖尿病病程长[比值比(OR)=2.053,95%可信区间(95%CI)1.425～2.985]、PDR Ⅵ期(OR=2.155,95%CI 1.436～3.234)、术前 HbA1c高(OR=1.982,95%CI 1.327～2.960)、术前未玻璃体腔注药(OR=2.208,95%CI 1.441～3.383)、合并增生视网膜牵引(OR=1.994,95%CI 1.372～2.898)、术后眼压高(OR=1.897,95%CI 1.329～2.708)均是影响PDR患者PPV后发生PVH的危险因素(P<0.05).依据多因素分析拟合PDR术后发生PVH的预测模型为Logit(P)=-6.254+0.719×糖尿病病程+0.768×PDR分期+0.684×术前 HbA1c+0.792×术前玻璃体腔注药+0.690×合并增生视网膜牵引+0.640×术后眼压.受试者工作特征曲线分析显示,模型预测PDR患者术后发生PVH的曲线下面积为0.952(95%CI 0.920～0.990),敏感度为0.901,特异度为0.954.结论 PDR患者PPV后PVH的发生受糖尿病病程、PDR分期、术前 HbA1c、术前玻璃体腔注药、合并增生视网膜牵引、术后眼压等因素的影响,且根据多因素结果构建的预测模型可提高PVH发生风险预测效能.
Objective To analyze the risk factors for postoperative rebleeding in proliferative diabetic retinopathy(PDR)and to construct a predictive model.Methods Clinical data of 334 PDR patients who un-derwent standardized 25-gauge pars plana vitrectomy(PPV)at this hospital from June 2021 to December 2024 were retrospectively analyzed.All patients were followed up for 6 months,during which postoperative vitreous hemorrhage(PVH)occurred in 60 cases.Multivariate logistic regression was used to identify independent risk factors for PVH after PPV,and a predictive model was established.Results Compared with the non-PVH group,the PVH group had significantly higher best corrected visual acuity at 3 and 6 months postoperatively,as well as higher proportions of patients with PDR stage Ⅵ,no preoperative intravitreal injection,and concom-itant proliferative retinal traction;additionally,longer diabetes duration,higher preoperative glycated hemo-globin(HbA1c),and higher postoperative intraocular pressure were observed in the PVH group,the differ-ences were all statistically significant(P<0.05).Multivariate analysis identified longer diabetes duration[odds ratio(OR)=2.053,95%CI 1.425-2.985],PDR stage Ⅵ(OR=2.155,95%CI 1.436-3.234),higher preoperative HbA1c(OR=1.982,95%CI 1.327-2.960),no preoperative intravitreal injection(OR=2.208,95%CI 1.441-3.383),concomitant proliferative retinal traction(OR=1.994,95%CI 1.372-2.898),and higher postoperative intraocular pressure(OR=1.897,95%CI 1.329-2.708)as independent risk factors for PVH after PPV(P<0.05).The predictive model was constructed as:Logit(P)=-6.254+0.719×diabe-tes duration+0.768×PDR stage+0.684×preoperative HbA1c+0.792×preoperative intravitreal injection+0.690×concomitant proliferative retinal traction+0.640×postoperative intraocular pressure.Receiver operat-ing characteristic curve analysis showed that the model had an area under the curve of 0.952(95%CI 0.920-0.990),with a sensitivity of 0.901 and specificity of 0.954.Conclusion The occurrence of PVH after PPV in PDR patients is influenced by diabetes duration,PDR stage,preoperative HbA1c,preoperative intravitreal in-jection,concomitant proliferative retinal traction,and postoperative intraocular pressure.The predictive model based on these multivariate results demonstrates good performance in predicting the risk of PVH.
孙岩;杨晓;郑佁博
南阳市中心医院静脉用药调配中心,河南 南阳 473000南阳市中心医院静脉用药调配中心,河南 南阳 473000南阳市中心医院静脉用药调配中心,河南 南阳 473000
医药卫生
增生性糖尿病视网膜病变玻璃体切割术玻璃体再出血影响因素预测模型
Proliferative diabetic retinopathyVitrectomyVitreous hemorrhageInfluencing factorsPredictive model
《现代医药卫生》 2026 (6)
1260-1264,5
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