角膜移植术后并发干眼的影响因素分析及列线图预测模型构建

Analysis of factors influencing the complication of dry eye after corneal transplantation and construction of nomogram predictive model

摘要:

目的：分析角膜移植术后并发干眼的影响因素，并构建预测角膜移植术后并发干眼的列线图预测模型。

方法：收集2021-03/2023-02于我院行角膜移植术的患者117例的临床资料。根据术后是否并发干眼分为干眼组(n=96)和非干眼组(n=21)，分析角膜移植术后并发干眼的危险因素，构建预测角膜移植术后并发干眼的列线图预测模型，模型的内部验证和预测效能分别用校正曲线、决策曲线评估。

结果：合并糖尿病、合并睡眠障碍、合并睑板腺功能障碍、长期滥用滴眼液、长期配戴角膜接触镜、泪液中白介素-6(IL-6)和肿瘤坏死因子-α(TNF-α)水平是角膜移植术后并发干眼的危险因素(P<0.05)。列线图预测模型预测角膜移植术后并发干眼的C-index为0.890(95%CI 0.877-0.903)； 列线图预测模型的阈值>0.07，列线图预测模型提供的临床净收益均高于单一指标。

结论：基于角膜移植术后并发干眼的影响因素所构建的列线图预测模型对角膜移植术后并发干眼的预测价值较好。

Abstract:

AIM: To analyze the influencing factors of postoperative dry eye complication after corneal transplantation and to build a nomogram prediction model.

METHODS: Clinical data were collected on 117 patients who underwent corneal transplantation at our hospital from March 2021 to February 2023. They were divided into dry eye group(n=96)and non-dry eye group(n=21)according to whether there was a postoperative dry eye. The risk factors of postoperative complication of dry eye after corneal transplantation were analyzed, the nomogram prediction model for predicting postoperative complication of dry eye after corneal transplantation was constructed, and the internal validation of the model and the prediction efficacy were assessed by calibration curves and decision curves, respectively.

RESULTS: Comorbid diabetes mellitus, comorbid sleep disorders, comorbid meibomian gland dysfunction, chronic eye drop abuse, chronic corneal contact lens wear, interleukin-6(IL-6), and tumor necrosis factor-α(TNF-α)were the risk factors for the complication of dry eye after corneal transplantation(P<0.05). The nomogram model predicted a C-index of 0.890(95% CI 0.877-0.903). The nomogram model had a threshold >0.07, and the nomogram model provided higher net clinical benefit than the single index in all cases.

CONCLUSION: The nomogram model built in this study based on the factors affecting the complication of dry eye after corneal transplantation has a good predictive value for the complication of dry eye after corneal transplantation.