摘要
目的分析共同性外斜视术后早期复发的相关风险因素,建立Nomogram预测模型。方法回顾性分析我院2015年10月至2021年10月收治的243例(486眼)共同性外斜视患者,按7:3的比例将其分为训练集(n=170)、验证集(n=73)。利用Lasso回归、Boruta算法、随机森林算法筛选共同性外斜视术后早期复发的风险变量。通过Spearman相关性分析及膨胀因子(VIF)评估变量之间的共线性,利用多因素Cox回归建立Nomogram预测模型。对该模型在术后6个月、18个月、24个月的受试者工作曲线、校准曲线、临床决策曲线进行效能评价。结果通过3种机器学习方法:Lasso回归、Boruta算法、随机森林算法,在训练集及验证集的22个风险变量中筛选出6个可能导致斜视术后早期复发的重要变量:斜视类型、发病年龄、术前斜视度数、右眼最佳矫正视力(BCVA)、左眼BCVA、手术方式,6个变量之间不存在共线性(r<0.6,VIF<5)。多因素Cox回归发现,斜视类型(间歇性外斜视)、术前斜视度数、右眼BCVA、左眼BCVA、手术方式(单侧外直肌后徙术)是共同性外斜视术后早期复发的风险因素,并构建Nomogram预测模型。受试者工作曲线、校准曲线及临床决策曲线提示该预测模型具有较好的准确度、一致性及临床适用度。结论Nomogram预测模型能较好预测共同性外斜视患者术后的早期复发风险,为眼科医生对患者进行早期干预提供参考。
Objective To analyze the risk factors associated with early recurrence after surgery for concomitant exotropia and establish a Nomogram prediction model.Methods A retrospective analysis was conducted on 243 cases(486 eyes)of concomitant exotropia treated in the Ophthalmology Department of our hospital from October 2015 to October 2021.The patients were divided into a training set(n=170)and a validation set(n=73)at a ratio of 7:3.The Lasso regression,Boruta algorithm,and random forest algorithm were used to screen risk variables related to postoperative recurrence of concomitant exotropia.The Spearman correlation analysis and variance inflation factor(VIF)were used to assess collinearity among variables,and a Nomogram prediction model was established using multivariate Cox regression.The receiver operating characteristic curve,calibration curve,and clinical decision curve of the model at 6 months,18 months,and 24 months after surgery were used to assess the efficacy of the model.Results Three machine learning methods including Lasso regression,Boruta algorithm,and random forest algorithm identified six significant variables that might contribute to early recurrence after strabismus surgery from 22 risk variables in both training and validation sets.No collinearity was found among the six variables(r<0.6,VIF<5).Multivariate Cox regression revealed that strabismus type(intermittent exotropia),preoperative strabismus angle,best-corrected visual acuity(BCVA)in the right eye,BCVA in both eyes,and surgical procedures(unilateral lateral rectus recession)were risk factors for early recurrence after surgery for concomitant exotropia.Meanwhile,a Nomogram prediction model was constructed based on these 6 factors.The receiver operating characteristic,calibration,and clinical decision curves indicated that the prediction model had good accuracy,consistency,and clinical applicability.Conclusion Nomogram prediction model can effectively predict the risk of early recurrence after surgery for concomitant exotropia,and provides a reference for ophthalmologists to intervene early in patients.
作者
谢婧
蒲丽
王正静
胡红芳
冯亮
赵粟
XIE Jing;PU Li;WANG Zhengjing;HU Hongfang;FENG Liang;ZHAO Su(Department of Ophthalmology,Affiliated Hospital of Guizhou Medical University,Guiyang 550004,Guizhou Province,China;Guizhou Medical University,Guiyang 550004,Guizhou Province,China;Guiyang Aier Eye Hospital,Guiyang 550005,Guizhou Province,China)
出处
《眼科新进展》
北大核心
2025年第2期115-119,共5页
Recent Advances in Ophthalmology
基金
国家自然科学基金资助项目(编号:82260208)
贵州医科大学博士启动基金项目(编号:gyfybsky-2022-06)。
