视网膜分支静脉阻塞性黄斑水肿患者复发风险模型的构建与验证-现代医学

视网膜分支静脉阻塞性黄斑水肿患者复发风险模型的构建与验证

单位：甘孜藏族自治州人民医院眼科, 四川甘孜 626000

分类号：R774.5

出版年·卷·期（页码）：2026·54·第二期（266-273）

摘要：

目的： 探索视网膜分支静脉阻塞性(branch retinal vein occlusion, BRVO)黄斑水肿(macular edema, ME)患者复发的影响因素，构建复发预测模型并验证。方法： 选取本院115例BRVO-ME患者，按照7∶3比例随机分为训练集(81例)与验证集(34例)，根据患者是否复发分为复发组和未复发组。多因素Logistic回归分析BRVO-ME患者复发的影响因素。进一步构建列线图模型并评估模型预测效能。结果： 复发组和未复发组年龄、视网膜间液、黄斑灌注和黄斑中心凹厚度(central macular thickness,CMT)比较差异有统计学意义(P＜0.05)。年龄≥60岁(OR=3.210,95%CI 1.417～7.273)、存在视网膜间液(OR=3.936,95%CI 1.197～12.937)和CMT(OR=1.016,95%CI 1.003～1.030)是BRVO-ME患者复发的危险因素，黄斑灌注(OR=0.016,95%CI 0.014～0.279)是保护因素(均P＜0.05)。采用训练集的数据从区分度和一致性两个方面对模型进行验证，训练集结果显示受试者工作特征曲线下面积(area under the curve,AUC)为0.876，准确度为0.83(0.79～0.91)，灵敏度为0.82(0.76～0.89)，特异度为0.85(0.81～0.94)，截断值为0.264。验证集结果显示，AUC为0.891，准确度为0.86(0.81～0.93)，灵敏度为0.84(0.79～0.89)，特异度为0.87(0.82～0.94)，截断值为0.272。训练集、验证集患者复发的列线图校准曲线斜率为0.845、0.764，拟合优度检验结果显示，预测概率和实际概率比较，差异无统计学意义(χ²=7.386、7.293，P=0.498、0.505)。结论： 本研究显示年龄≥60岁、存在视网膜间液和CMT是BRVO-ME患者复发的危险因素，黄斑灌注是BRVO-ME患者复发的保护因素。BRVO-ME患者复发预测模型具有较好的预测价值，可为临床BRVO-ME患者复发尽早识别和干预提供参考。

Objective: To explore the factors influencing the recurrence of macular edema(ME) in patients with branch retinal vein occlusion(BRVO), and to develop and validate a recurrence prediction model. Methods: A total of 115 BRVO-ME patients from our hospital were selected and randomly divided into a training set(81 cases) and a validation set(34 cases) in a 7∶3 ratio. All patients were categorized into the recurrence group and non-recurrence group based on whether they experienced a recurrence. Multivariate logistic regression analysis was used to identify factors influencing the recurrence of BRVO-ME. A nomogram model was constructed, and the predictive performance of the model was evaluated. Results: There were significant differences in age, interretinal fluid, macular perfusion, and central macular thickness(CMT) between the relapse group and the non-relapse group(P<0.05). Age ≥60 years(OR=3.210,95%CI 1.417-7.273), presence of interretinal fluid(OR=3.936, 95%CI 1.197-12.937) and CMT(OR=1.016, 95%CI 1.003-1.030) were risk factors for recurrence in BRVO-ME patients, and macular perfusion(OR=0.016, 95%CI 0.014-0.279) was a protective factor(all P<0.05). The results of the training set show that the area under the curve(AUC) is 0.876, the accuracy is 0.83(0.79-0.91), the sensitivity is 0.82(0.76-0.89), the specificity is 0.85(0.81-0.94), and the cut-off value is 0.264, respectively. Meanwhile, the results of the validation set showed that the AUC was 0.891, the accuracy was 0.86(0.81-0.93), the sensitivity was 0.84(0.79-0.89), the specificity was 0.87(0.82-0.94), and the cut-off value was 0.272. The slope of the nomogram calibration curve of patients with recurrence in the training set and validation set was 0.845 and 0.764, and the results of the goodness-of-fit test showed that there was no statistically significant difference between the predicted probability and the actual probability(χ²=7.386 and 7.293, P=0.498 and 0.505, respectively). Conclusion: This study established a predictive model for recurrence in BRVO-ME patients, which has good predictive value. Age ≥60 years, the presence of intraretinal fluid, and CMT are risk factors for recurrence in BRVO-ME patients, while macular perfusion is a protective factor, which can assist clinicians in early intervention and improve patients' quality of life.

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