上睑下垂矫正术后发生暴露性角膜炎的nomogram预测模型建立及临床价值分析

Establishment and Clinical Value Analysis of Nomogram Prediction Model for Exposure Keratitis After Upper Eyelid Ptosis Correction Surgery

目的探究上睑下垂矫正术后发生暴露性角膜炎的危险因素,建立预测暴露性角膜炎发生的列线图nomogram模型并分析其临床应用价值。方法收集2021年1月至2023年6月于郑州市第二人民医院接受上睑下垂矫正手术的165例患者为研究对象。以多因素分析得出的独立危险因素创建列线图模型。通过受试者工作特征(ROC)曲线及校正曲线验证模型的区分度和一致性。通过决策曲线分析(DCA)评估模型的临床应用范围。结果单因素分析显示,暴露性角膜炎组和未暴露性角膜炎组患者性别和年龄差异无统计学意义(P>0.05),Bell’s征、修复次数、干眼症、手术方式、角膜接触镜差异有统计学意义(P<0.05)。多因素结果显示,Bell’s征阴性、修复次数≥1次、干眼症、额肌悬吊术、不佩戴角膜接触镜是上睑下垂矫正术后发生暴露性角膜炎的独立危险因素。ROC的曲线下面积(AUC)为0.840,区分度较高。校准曲线表现出较高的一致性,DCA结果显示nomogram模型预测术后暴露性角膜炎有较好的实用性和安全性。结论Bell’s征阴性、修复次数≥1次、有干眼症、无角膜接触镜佩戴以及额肌悬吊术等因素是上睑下垂矫正术后暴露性角膜炎发生的独立危险因素,基于这些因素构建的列线图模型准确度高,对于预测暴露性角膜炎的发生具有较高的临床应用价值。

Objective To investigate the risk factors for the development of exposure keratitis after ptosis correction,to develop a nomogram model for predicting the development of exposure keratitis,and to analyze the clinical value of its application.Methods A total of 165 patients who underwent ptosis correction surgery in Zhengzhou Second People’s Hospital from January 2021 to June 2023 were collected as study subjects.Independent risk factors derived from the multifactorial analysis were used to create a column-line graphical model.The discrimination and consistency of the model were verified by receiver operating characteristic(ROC)curve and calibration curves,and the scope of clinical application of the model was assessed by decision curve analysis(DCA).Results Univariate analysis showed no statistically differences between the exposed keratitis group and unexposed keratitis group in terms of gender and age(P>0.05),whereas the differences were statistically significant compared to Bell’s sign,number of repairs,dry eye,surgical procedure,and corneal contact lenses(P<0.05).The multivariate results showed negative Bell’s sign,number of repairs≥1,dry eye,frontal muscle suspension,and not wearing corneal contact lenses were the independent risk factors for the development of exposure keratitis after ptosis correction.The area under the curve(AUC)of the ROC was 0.840,with a high degree of discrimination.The calibration curves showed high consistency,and the DCA results indicated that the nomogram model has good utility and safety in predicting the occurrence of postoperative exposure keratitis.Conclusion Bell’s sign negative,repair times≥1,dry eye,no contact lens wearing,and frontal muscle suspension can be considered as independent risk factors for exposure keratitis.The Nomogram model based on these factors has high accuracy and has high clinical application value for predicting the occurrence of exposed keratitis.