Qiao D N, Dong P F, Lu S H, Chen H L
Nursing Department, the Second Affiliated Hospital of Zhejiang University School of Medicine, Hangzhou 310009, China.
Zhonghua Yi Xue Za Zhi. 2023 Sep 26;103(36):2859-2866. doi: 10.3760/cma.j.cn112137-20230530-00886.
To establish and validate a risk predictive model of preoperative drug-induced limitation of pupil dilation (PD) in type 2 diabetes mellitus (T2DM) patients with concomitant cataract. A cross-sectional study was performed, in which 376 T2DM patients with concomitant cataract who received cataract operation in the Second Affiliated Hospital of Zhejiang University School of Medicine from October 2022 to March 2023 were randomly selected as the study subjects. Of the 376 patients, 268 who were admitted to the hospital from October to December 2022 served as the modeling group, and were divided into PD limited group (=187) and PD unlimited group (=81) based on whether they had drug-induced limitation of PD. Logistic regression was used to establish a risk predictive model, R software was used to draw the nomogram, Hosmer-Lemeshow test was utilized to judge the model's goodness of fit, and receiver operating characteristic (ROC) curve was adopted to validate the predicting efficacy of the model. Another 108 T2DM patients who received cataract operation in the same hospital from January to March 2023 served as the validation group, and Hosmer-Lemeshow test and ROC curve were used for the external validation of the model. In the modeling group (=268), there were 124 males and 144 females, with the mean age of (66.6±6.8) years, while in the validation group (=108), there were 51 males and 57 females, with the mean age of (64.9±9.1) years. The incidence of preoperative drug-induced limitation of PD was 69.8% (187/268) in T2DM patients with concomitant cataract. T2DM disease course (=1.134, 95%: 1.074-1.198, <0.001), body mass index (BMI) (=0.863, 95%: 0.767-0.972, =0.015), glycohemoglobin (HbA1c) level (=1.397, 95%: 1.055-1.849, =0.019) and baseline pupil dimeter (=0.089, 95%: 0.045-0.179, <0.001) were the risk factors of drug-induced limitation of PD. Hosmer-Lemeshow test showed χ=6.231 and =0.621, the area under curve (AUC) of ROC curve was 0.897 (95%: 0.857-0.937, <0.001), and when the Youden index was the maximum (0.655), the model's sensitivity and specificity was 0.877 and 0.778, respectively. The external validation results demonstrated that the AUC of ROC curve was 0.928 (95%: 0.875-0.981, <0.001), the maximum Youden index was 0.761, the sensitivity was 0.932, the specificity was 0.829, and the overall accuracy was 89.8%. The risk predictive model established in the current study can provide reference for the clinical assessment of the risk of preoperative drug-induced limitation of PD in T2DM patients with concomitant cataract.
建立并验证2型糖尿病（T2DM）合并白内障患者术前药物性瞳孔散大受限（PD）的风险预测模型。进行了一项横断面研究，随机选取2022年10月至2023年3月在浙江大学医学院附属第二医院接受白内障手术的376例T2DM合并白内障患者作为研究对象。在这376例患者中，2022年10月至12月入院的268例作为建模组，根据是否存在药物性PD受限分为PD受限组（n = 187）和PD不受限组（n = 81）。采用Logistic回归建立风险预测模型，使用R软件绘制列线图，采用Hosmer-Lemeshow检验判断模型的拟合优度，采用受试者操作特征（ROC）曲线验证模型的预测效能。2023年1月至3月在同一医院接受白内障手术的另外108例T2DM患者作为验证组，采用Hosmer-Lemeshow检验和ROC曲线对模型进行外部验证。建模组（n = 268）中，男性124例，女性144例，平均年龄（66.6±6.8）岁；验证组（n = 108）中，男性51例，女性57例，平均年龄（64.9±9.1）岁。T2DM合并白内障患者术前药物性PD受限的发生率为69.8%（187/268）。T2DM病程（β = 1.134，95%CI：1.074 - 1.198，P < 0.001）、体重指数（BMI）（β = 0.863，95%CI：0.767 - 0.972，P = 0.015）、糖化血红蛋白（HbA1c）水平（β = 1.397，95%CI：1.055 - 1.849，P = 0.019）和基线瞳孔直径（β = 0.089，95%CI：0.045 - 0.179，P < 0.001）是药物性PD受限的危险因素。Hosmer-Lemeshow检验显示χ² = 6.231，P = 0.621，ROC曲线下面积（AUC）为0.897（95%CI：0.857 - 0.937，P < 0.001），当约登指数最大（0.655）时，模型的灵敏度和特异度分别为0.877和0.778。外部验证结果显示，ROC曲线的AUC为0.928（95%CI：0.875 - 0.981，P < 0.001），最大约登指数为0.761，灵敏度为0.932，特异度为0.829，总体准确率为89.8%。本研究建立的风险预测模型可为T2DM合并白内障患者术前药物性PD受限风险的临床评估提供参考。
