翼状胬肉术后复发Nomogram预测模型的构建与评估

董彦平; 王洁敏; 王玉瑾; 任娅丽; 董玉成; 雍焱隽; 苏渲迪; 王吉翔; 苏楠; 王福利; 夏多胜

doi:10.7619/jcmp.20214610

翼状胬肉术后复发Nomogram预测模型的构建与评估

Construction and evaluation of Nomogram prediction model for postoperative recurrence of pterygium

摘要

摘要:
目的分析甘南少数民族地区翼状胬肉患者术后复发的危险因素，根据结果构建Nomogram预测模型并进行评估。
方法以随机整群抽查的方式在甘南少数民族地区选取296例(296眼)经翼状胬肉切除术治疗的患者进行回顾性研究，根据患者术后1年复发情况分为复发组和未复发组。采用单因素及多因素Logistic回归模型分析影响翼状胬肉复发的危险因素。在此基础上构建Nomogram预测模型，绘制受试者工作特征(ROC)曲线及H-L拟合度曲线以评估模型的区分度及有效性。
结果本研究共纳入296例患者，其中术后1年复发者45例，复发率为15.20%。多因素Logistic回归模型分析结果显示，日间户外活动时间较长、内直肌止端距角膜缘距离较短、泪膜破裂时间短、合并干眼症是影响甘南少数民族地区翼状胬肉患者术后复发的独立危险因素(P < 0.05)。ROC曲线的曲线下面积为0.901, 敏感度、特异度分别为86.67%、88.84%(95%CI为0.826~0.924); H-L拟合度曲线显示拟合度良好(χ²=6.421, P=0.431)。
结论日间户外活动时间较长、内直肌止端距角膜缘距离较短、泪膜破裂时间短、合并干眼症是影响甘南少数民族地区翼状胬肉患者术后复发的独立危险因素。据此构建的Nomogram预测模型具有较好的区分度及有效性，可作为临床评估甘南少数民族地区翼状胬肉患者术后复发风险的有效工具。

Abstract:
Objective To analyze the risk factors of postoperative recurrence of pterygium patients in Gannan regions inhabited by ethnic groups, and to construct and evaluate the Nomogram prediction model based on results.
Methods A retrospective study was performed for 296 cases (296 eyes) of patients with excision of pterygium in Gannan regions inhabited by ethnic groups in the way of random cluster sampling, and the patients were divided into recurrence group and non-recurrence group according to recurrence status at one year after operation. Univariate and multivariate Logistic regression models were used to analyze the risk factors of recurrence of pterygium. On this basis, a Nomogram prediction model was constructed, and receiver operating characteristic (ROC) curve and H-L fitting curve were drawn to evaluate the discrimination and effectiveness of the model.
Results A total of 296 patients were included in this study, of which 45 recurred one year after operation, and the recurrence rate was 15.20%. The results of multivariate Logistic regression model showed that the longer daytime outdoor activities, short distance between the medial rectus muscle stop and the corneal limbus, short tear film rupture time and xerophthalmia were the independent risk factors affecting postoperative recurrence of patients with pterygium in the Gannan regionsinhabited by ethnic groups (P < 0.05). The area under the curve of ROC curve was 0.901, and the sensitivity and specificity were 86.67% and 88.84%, respectively (95%CI, 0.826 to 0.924); the H-L fitting curve showed there was a good fitting result (χ²=6.421, P=0.431).
Conclusion Longer daytime outdoor activities, short distance between the medial rectus muscle stop and the corneal limbus, short tear film rupture time and xerophthalmia are the independent risk factors affecting postoperative recurrence of patients with pterygium in the Gannan regions inhabited by ethnic groups. The Nomogram prediction model constructed on these results has good differentiation and effectiveness, and it can be used as an effective tool for clinical evaluation of postoperative recurrence risk of pterygium patients in Gannan regions inhabited by ethnic groups.

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