个体化预测视网膜静脉阻塞性黄斑水肿患者复发风险的模型构建

Construction of a individualized model for predicting the risk of recurrence in patients with retinal vein occlusion induced macular edema

摘要:

目的：分析影响视网膜静脉阻塞(RVO)性黄斑水肿(ME)患者复发的因素并构建列线图模型。

方法：回顾性研究。纳入本院2019-01/2022-06期间收治的RVO性ME患者306例为研究对象，按7：3分为建模组214例214眼和验证组92例92眼。所有患者经抗血管内皮生长因子(VEGF)治疗后随访1 a，根据建模组患者是否复发分为复发组(n=66)和未复发组(n=148)。收集临床资料并采用多因素Logistic回归分析确定RVO性ME患者复发的影响因素； R3.6.3软件构建预测RVO性ME患者复发风险的列线图模型； ROC曲线和校准曲线评估列线图模型预测RVO性ME患者复发风险的区分度和一致性。

结果：未复发组和复发组患者治疗前黄斑中心凹视网膜厚度(CRT)、病程、高反射灶(HF)、视网膜内层结构紊乱、注药次数比较均有差异(均P<0.05)。多因素Logistic回归分析结果显示，治疗前CRT(OR=1.011)、病程(OR=1.104)、HF(OR=5.074)、视网膜内层结构紊乱(OR=4.640)、注药次数(OR=4.036)是RVO性ME患者复发的影响因素(均P<0.01)。建模组ROC曲线下面积为0.924(95%CI：0.882-0.966)，校准曲线斜率接近1，Hosmer-Lemeshow拟合优度检验结果显示χ²=11.817，P=0.160； 验证组ROC曲线下面积为0.939(95%CI：0.892-0.985)，校准曲线斜率接近1，Hosmer-Lemeshow拟合优度检验结果显示χ²=6.082，P=0.638。

结论：治疗前CRT、病程、HF、视网膜内层结构紊乱、注药次数是RVO性ME患者复发的独立危险因素，基于此构建的列线图模型在预测RVO性ME患者的复发风险上具有较高的区分度和一致性。

Abstract:

AIM: To analyze the recurrence factors of patients with retinal vein occlusion(RVO)induced macular edema(ME)and construct a nomogram model.

METHODS: Retrospective study. A total of 306 patients with RVO induced ME admitted to our hospital from January 2019 to June 2022 were included as study objects, and they were divided into modeling group with 214 cases(214 eyes)and 92 cases(92 eyes)in the verification group by 7:3. All patients were followed up for 1 a after receiving anti-vascular endothelial growth factor(VEGF)treatment, and patients in the modeling group were separated into a recurrence group(n=66)and a non recurrence group(n=148)based on whether they had recurrence. Clinical data were collected and multivariate Logistic regression was applied to analyze and determine the factors affecting recurrence in patients with RVO induced ME; R3.6.3 software was applied to construct a nomogram model for predicting the recurrence risk of patients with RVO induced ME; ROC curve and calibration curve were applied to evaluate the discrimination and consistency of nomogram model in predicting the recurrence risk of patients with RVO induced ME.

RESULTS: There were statistically significant differences in central retinal thickness(CRT), course of disease, hyperreflective foci(HF), disorder of retinal inner layer structure, and injection frequency between the non recurrence group and the recurrence group before treatment(all P<0.05). The multivariate Logistic regression analysis showed that pre-treatment CRT(OR=1.011), course of disease(OR=1.104), HF(OR=5.074), retinal inner layer structural disorder(OR=4.640), and injection frequency(OR=4.036)were influencing factors for recurrence in patients with RVO induced ME(all P<0.01). The area under the ROC curve of the modeling group was 0.924(95%CI: 0.882-0.966), the slope of the calibration curve was close to 1, and the results of the Hosmer-Lemeshow goodness of fit test showed that χ²=11.817, P=0.160; the area under the ROC curve of the verification group was 0.939(95%CI: 0.892-0.985), the slope of the calibration curve was close to 1, and the results of the Hosmer-Lemeshow goodness of fit test showed χ²=6.082, P=0.638.

CONCLUSION: Pre-treatment CRT, course of disease, HF, disorder of retinal inner layer structure, and injection frequency are independent risk factors for recurrence in patients with RVO induced ME. The nomogram model constructed based on this has a high discrimination and consistency in predicting the recurrence risk of patients with RVO induced ME.