视网膜脱离复位术后患者心理状态的列线图预测模型构建及验证

Construction of nomogram predictive model for mental state in patients after retinal detachment reduction surgery and its verification

  • 摘要:
    目的 基于视网膜脱离复位术后患者心理状态的影响因素构建列线图预测模型, 并验证模型的预测效能。
    方法 收集238例视网膜脱离复位术患者的临床资料,按照6∶4比例将纳入对象分为建模组143例和验证组95例; 采用焦虑自评量表(SAS)、抑郁自评量表(SDS)评估患者的不良心理状态; 采用单因素和多因素Logistic回归分析明确视网膜脱离复位术后患者心理状态的影响因素,并建立风险预测模型; 绘制受试者工作特征(ROC)曲线、校准曲线评估模型的预测效能,并进行Hosmer-Lemeshow拟合优度检验。
    结果 建模组143例患者中, 96例(67.13%)出现负性心理状态; 单因素分析结果显示,年龄、经济压力、合并慢性病、失眠、视网膜脱离距手术时间、另眼视力情况均为视网膜脱离复位术后患者心理状态的影响因素(P < 0.05); 多因素Logistic回归分析结果显示,年龄 < 55岁(OR=3.214)、有经济压力(OR=3.328)、合并慢性病(OR=3.631)、失眠(OR=7.886)、视网膜脱离距手术时间>7 d(OR=5.897)、另眼存在视力缺陷(OR=6.133)均为患者负性心理状态的独立危险因素(P < 0.05)。Hosmer-Lemeshow拟合优度检验结果显示,基于影响因素构建的列线图模型在建模组(χ2=6.470, P=0.595)、验证组(χ2=6.343, P=0.535)中均具有良好的校准度; 校准曲线显示, 列线图模型在建模组和验证组中预测的负性心理状态发生风险与实际发生风险具有良好一致性; ROC曲线显示,列线图模型在建模组、验证组中预测负性心理状态的曲线下面积分别为0.909(95%CI: 0.849~0.951)、0.902(95%CI: 0.824~0.954)。
    结论 根据视网膜脱离复位术后患者心理状态的影响因素(年龄、经济压力、合并慢性病、失眠、视网膜脱离距手术时间、另眼视力情况)构建的列线图预测模型区分度、有效性均良好,可为此类患者临床治疗方案的选择提供参考依据。

     

    Abstract:
    Objective To construct a predictive model for the psychological state of patients after retinal detachment reduction, and to verify the predictive effect of the model.
    Methods The clinical data of 238 patients who underwent retinal detachment reduction were collected, the included subjects were divided into modeling group (143 cases) and validation group (95 cases) at a ratio of 6∶4; Self-rating Anxiety Scale (SAS) and Self-rating Depression Scale (SDS) were used to evaluate the poor psychological state of patients; univariate and multivariate Logistic regression analysis were used to analyze the risk factors affecting the psychological state of patients after retinal detachment, and a risk prediction model was established. Receiver operating characteristic (ROC) curve and calibration curve were drawn to evaluate the predictive effectiveness of the model, and Hosmer-Lemeshow goodness-of-fit test was performed.
    Results In 143 patients in the modeling group, 96 patients(67.13%) with retinal detachment had negative psychological state; the results of univariate analysis showed that age, economic pressure, complicating with chronic diseases, insomnia, time since preoperative retinal detachment, and visual acuity of the other eye were the influencing factors of the psychological state of patients after retinal detachment (P < 0.05); multivariate Logistic regression analysis showed that age < 55 years old (OR=3.214), financial stress (OR=3.328), complicating with chronic disease (OR=3.631), insomnia (OR=7.886), time since preoperative retinal detachment (>7 d) (OR=5.897) and visual impairment in the other eye (OR=6.133) were risk factors for negative psychology (P < 0.05). The results of the Hosmer-Lemeshow goodness of fit test showed that established model based on risk factors had a good degree of calibration in both modeling group(χ2=6.470, P=0.595)and validation group(χ2=6.343, P=0.535); the calibration curves of the modeling group and the validation group showed that the risk of negative emotions predicted by the model was in good agreement with the risk that actually occurred; the results of the ROC curve showed that the area under the curve for predicting the occurrence of negative emotions in the modeling group and the validation group was 0.909 (95%CI, 0.849 to 0.951) and 0.902 (95%CI, 0.824 to 0.954), respectively.
    Conclusion Based on the influencing factors of psychological state in patients after retinal detachment repositioning (age, economic pressure, complicating with chronic diseases, insomnia, time from retinal detachment to surgery, visual acuity of the other eye), the nomogram prediction model has better differentiation, effectiveness, which can provide a reference for the selection of clinical treatment for such patients.

     

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