中国患者飞秒激光辅助穿透角膜移植失败的预测模型：一项为期两年的研究
IF 2.6
3区 医学
Q2 OPHTHALMOLOGY
Ophthalmology and Therapy
Pub Date : 2024-07-01
Epub Date: 2024-05-14
DOI:10.1007/s40123-024-00955-6
引用次数: 0
摘要
导言：移植物失败是飞秒激光辅助穿透性角膜移植术（Fs-PKP）的一大挑战。本研究重点关注临床预测模型的开发和验证，旨在识别中国接受飞秒激光辅助穿透性角膜成形术（Fs-PKP）患者的移植物失败风险，为改善手术效果提供量身定制的方法：这项在南京市第一医院进行的回顾性队列研究涉及238名患者，遵循了TRIPOD声明。队列按 7:3 的比例分为训练集（166 人）和验证集（72 人）。研究分析了与受体、供体和手术因素相关的 23 个预测变量，并将移植物失败定义为 "视觉上明显且不可逆转的角膜基质水肿、混浊或瘢痕"。使用单变量和多变量考克斯回归分析创建了一个综合提名图，并通过一致性指数（C-index）、时间依赖性接收者操作特征曲线（ROC）、校准图和决策曲线分析（DCA）进行了评估：结果：确定了五个关键风险因素：受者的全身自身免疫性疾病史、眼外伤、先前的穿透性角膜移植术（PKP）史、供体的糖尿病史和供体角膜的内皮细胞密度。在训练组和验证组中，提名图的 C 指数分别为 0.72（95% CI 0.65-0.79）和 0.66（95% CI 0.55-0.76），表明预测准确性很高。与时间相关的ROC曲线、校准图和DCA一致验证了该模型在训练组和验证组中的可靠性、预测能力和临床实用性：我们的研究建立并验证了一个包含五个关键因素的模型，从而加强了对中国 Fs-PKP 移植失败患者的术前预测和管理。本文章由计算机程序翻译，如有差异，请以英文原文为准。
A Predictive Model for Graft Failure in Femtosecond Laser-Assisted Penetrating Keratoplasty Among Chinese Patients: A 2-Year Study.
Introduction: Graft failure is a major challenge in femtosecond laser-assisted penetrating keratoplasty (Fs-PKP). This study focuses on the development and validation of a clinical predictive model aimed at identifying the risk of graft failure in individuals undergoing Fs-PKP in China, offering a tailored approach to improve surgical outcomes.
Methods: This retrospective cohort study at Nanjing First Hospital involved 238 patients and followed the TRIPOD statement. The cohort was divided into a training set (n = 166) and a validation set (n = 72) in a 7:3 ratio. It analyzed 23 predictor variables related to recipient, donor, and surgical factors, defining graft failure as "visually significant and irreversible corneal stromal edema, haze, or scarring." A comprehensive nomogram was created using univariate and multivariate Cox regression analyses and assessed by concordance index (C-index), time-dependent receiver operating characteristics (ROC) curve, calibration plots, and decision curve analysis (DCA).
Results: Five critical risk factors were identified: recipients' history of systemic autoimmune disorders, ocular trauma, prior penetrating keratoplasty (PKP) history, donors' diabetes history, and the endothelial cell density of the donor cornea. The nomogram showed a C-index of 0.72 (95% CI 0.65-0.79) in the training group and 0.66 (95% CI 0.55-0.76) in the validation group, indicating robust predictive accuracy. Time-dependent ROC curves, calibration plots, and DCA consistently validated the model's reliability, predictive power, and clinical utility across both training and validation cohorts.
Conclusions: Our study developed and validated a model incorporating five key factors, enhancing preoperative prediction and management for Chinese patients with Fs-PKP graft failure.
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来源期刊
Ophthalmology and Therapy
OPHTHALMOLOGY-
CiteScore
4.20
自引率
3.00%
发文量
157
审稿时长
6 weeks
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