老年葡萄膜炎并发白内障的危险因素和预测模型构建

doi:10.3969/j.issn.1003-9198.2025.08.017

摘要/Abstract

摘要： 目的探讨老年葡萄膜炎并发白内障的危险因素,构建列线图预测模型。方法回顾性选取2021年3月至2024年3月华中科技大学同济医学院附属协和医院眼科收治的223例葡萄膜炎病人,收集临床相关资料,根据是否并发白内障将病人分为白内障组(116例)和非白内障组(107例)。采用多因素logistic回归分析老年葡萄膜炎病人并发白内障的相关因素,构建列线图预测模型并验证。结果疾病严重程度评分较高、葡萄膜炎发作次数≥2次/年、黄斑囊样水肿、糖尿病、长期使用糖皮质激素、年龄较大、白内障家族史是葡萄膜炎病人并发白内障的危险因素(P＜0.05)。基于回归分析结果构建的列线图预测模型具有良好的校准度(平均绝对误差为0.02,C-index 指数为0.851)和预测效能(ROC曲线下面积为0.885)。结论老年葡萄膜炎并发白内障的发生率较高,年龄、家族史、葡萄膜炎严重程度及发作次数、糖尿病、长期应用激素、合并黄斑囊样水肿等是相关危险因素,基于上述指标构建的列线图模型对老年葡萄膜炎并发白内障有较高的预测价值。

关键词: 葡萄膜炎, 危险因素, 预测模型, 白内障

Abstract: Objective To investigate the risk factors of cataract in the elderly patients with uveitis, and to establish a nomogram predictive model. Methods A total of 223 patients with uveitis admitted to Union Hospital, Tongji Medical College, Huazhong University of Science and Technology from March 2021 to March 2024 were retrospectively selected. Relevant clinical data were collected. All patients were divided into cataract group (116 cases) and non-cataract group (107 cases) based on the presence of cataract complications. Multivariate logistic regression analysis was conducted to analyze the related factors affecting cataract complications in the elderly patients with uveitis, and the prediction model was constructed and verified by nomogram. Results Higher disease severity score, the frequency of uveitis ≥2 times per year, cystoid macular edema (CME), diabetes, long-term use of glucocorticoids, older age and family history of cataract were identified as the risk factors for cataract in the elderly patients with uveitis (P < 0.05). The regression-based nomogram predictive model showed good calibration (mean absolute error=0.02) and discrimination (C-index=0.851). Its predictive performance was also excellent, with an area under the receiver operating characteristic curve of 0.885. Conclusions The incidence rate of cataract is high in the elderly patients with uveitis. Risk factors include advanced age, family history of cataract, severity of uveitis, diabetes and long-term use of hormones, and concomitant CME. The nomogram model constructed based on these factors shows high predictive value for cataract in the elderly patients with uveitis.

Key words: uveitis, risk factors, predictive model, cataract

中图分类号:

R776.1
R773

刘乔容, 薛朝华, 李鹏程. 老年葡萄膜炎并发白内障的危险因素和预测模型构建[J]. 实用老年医学, 2025, 39(8): 837-841.

LIU Qiaorong, XUE Chaohua, LI Pengcheng. Risk factors and predictive model construction for cataract in elderly patients with uveitis[J]. Practical Geriatrics, 2025, 39(8): 837-841.

参考文献

[1] GHADIRI N, REEKIEI R, GORDON I, et al. Systematic review of clinical practice guidelines for uveitis[J]. BMJ Open Ophthalmol, 2023, 8(1): e001091.
[2] HSUY R, HUANG J C, TAO Y, et al. Noninfectious uveitis in the Asia-Pacific Region[J]. Eye, 2019, 33(1): 66-77.
[3] MOSHIRFAR M, SOMANIA N, MOTLAGH M N, et al. Management of cataract in the setting of uveitis: a review of the current literature[J]. Curr Opin Ophthalmol, 2020, 31(1): 3-9.
[4] ZHANG Y, ZHU X, HE W, et al. Efficacy of cataract surgery in patients with uveitis: a STROBE-compliant article[J]. Medicine, 2017, 96(30): e7353.
[5] 杨培增. 葡萄膜炎诊断与治疗[M]. 北京: 人民卫生出版社, 2009: 58-70.
[6] 李凤鸣. 眼科全书[M]. 北京: 人民卫生出版社, 1996: 2670-2671.
[7] 唐红, 蔡莉, 惠延年. 葡萄膜炎患者外周血CD₄₊CD_25high调节性T细胞的表达[J]. 国际眼科杂志, 2008, 8(8): 1609-1611.
[8] 田芳, 张红, 袁佳琴. 黄斑囊样水肿诊断的新进展[J]. 中国实用眼科杂志, 2002,20(8): 563-565.
[9] 任成山, 王甲汉, 牛广政, 等. 现代临床疾病防治学[M]. 郑州: 郑州大学出版社, 2012: 965-966.
[10] BALTA O, SUNGUR G, ACARM A, et al. Long-term results of cataract surgery in patients with anterior uveitis[J]. Int Ophthalmol, 2018, 38(4): 1399-1407.
[11] PÅLSSON S, PIVODIC A, GRÖNLUNDM A, et al. Cataract surgery in patients with uveitis: data from the Swedish national cataract register[J]. Acta Ophthalmol, 2023, 101(4): 376-383.
[12] NETI N, PIMSRI A, BOONSOPON S, et al. Triggering factors associated with a new episode of recurrent acute anterior uveitis[J]. Sci Rep, 2021, 11(1): 12156.
[13] LIY H, HSU S L, SHEU S J. A review of local therapy for the management of cystoid macular edema in uveitis[J]. Asia Pac J Ophthalmol, 2021, 10(1): 87-92.
[14] BEK T, TILMA K, LA COUR M. The risk for developing vision-threatening retinopathy after cataract surgery in diabetic patients depends on the postoperative follow-up time[J]. Acta Ophthalmol, 2022, 100(3): e719-e725.
[15] KELKAR A, KELKAR J, MEHTA H, et al. Cataract surgery in diabetes mellitus:a systematic review[J]. Indian J Ophthalmol, 2018, 66(10): 1401-1410.
[16] TAIYAB A, BELAHLOU Y, WONG V, et al. Understanding the role of yes-associated protein (YAP) signaling in the transformation of lens epithelial cells (EMT) and fibrosis[J]. Biomolecules, 2023, 13(12): 1767.
[17] LI D, JING Q, JIANG Y. The identification and characterization of the p.G91 deletion in CRYBA1 in a Chinese family with congenital cataracts[J]. BMC Med Genet, 2019, 20(1): 153.