摘要
Abstract
Objective To analyze the risk factors for postoperative rebleeding in proliferative diabetic retinopathy(PDR)and to construct a predictive model.Methods Clinical data of 334 PDR patients who un-derwent standardized 25-gauge pars plana vitrectomy(PPV)at this hospital from June 2021 to December 2024 were retrospectively analyzed.All patients were followed up for 6 months,during which postoperative vitreous hemorrhage(PVH)occurred in 60 cases.Multivariate logistic regression was used to identify independent risk factors for PVH after PPV,and a predictive model was established.Results Compared with the non-PVH group,the PVH group had significantly higher best corrected visual acuity at 3 and 6 months postoperatively,as well as higher proportions of patients with PDR stage Ⅵ,no preoperative intravitreal injection,and concom-itant proliferative retinal traction;additionally,longer diabetes duration,higher preoperative glycated hemo-globin(HbA1c),and higher postoperative intraocular pressure were observed in the PVH group,the differ-ences were all statistically significant(P<0.05).Multivariate analysis identified longer diabetes duration[odds ratio(OR)=2.053,95%CI 1.425-2.985],PDR stage Ⅵ(OR=2.155,95%CI 1.436-3.234),higher preoperative HbA1c(OR=1.982,95%CI 1.327-2.960),no preoperative intravitreal injection(OR=2.208,95%CI 1.441-3.383),concomitant proliferative retinal traction(OR=1.994,95%CI 1.372-2.898),and higher postoperative intraocular pressure(OR=1.897,95%CI 1.329-2.708)as independent risk factors for PVH after PPV(P<0.05).The predictive model was constructed as:Logit(P)=-6.254+0.719×diabe-tes duration+0.768×PDR stage+0.684×preoperative HbA1c+0.792×preoperative intravitreal injection+0.690×concomitant proliferative retinal traction+0.640×postoperative intraocular pressure.Receiver operat-ing characteristic curve analysis showed that the model had an area under the curve of 0.952(95%CI 0.920-0.990),with a sensitivity of 0.901 and specificity of 0.954.Conclusion The occurrence of PVH after PPV in PDR patients is influenced by diabetes duration,PDR stage,preoperative HbA1c,preoperative intravitreal in-jection,concomitant proliferative retinal traction,and postoperative intraocular pressure.The predictive model based on these multivariate results demonstrates good performance in predicting the risk of PVH.关键词
增生性糖尿病视网膜病变/玻璃体切割术/玻璃体再出血/影响因素/预测模型Key words
Proliferative diabetic retinopathy/Vitrectomy/Vitreous hemorrhage/Influencing factors/Predictive model分类
医药卫生
