葡萄膜炎患者复发相关危险因素分析及复发预测模型的构建

摘要

背景 葡萄膜炎的反复发作是导致患者视力严重受损的主要原因,预测诱发葡萄膜炎复发的危险因素对于其预防和治疗具有重要意义. 目的 探讨葡萄膜炎患者复发的相关危险因素,构建葡萄膜炎复发的预测模型.方法 采用回顾性系列病例观察研究方法,收集2010年7月至2011年6月在三峡大学仁和医院确诊的葡萄膜炎患者的临床资料,对患者的人口基线特征资料和病变复发情况进行追踪随访,运用Kaplan-Meier法计算患者的复发率,绘制患者的无复发生存曲线;采用多因素Cox回归分析筛选影响患者复发的独立危险因素,并建立患者的复发预测模型.结果 共纳入符合条件的葡萄膜炎患者825例,随访1 ～38个月,中位随访时间为16个月.随访期间149例患者复发,占18.1％;本组患者的无复发生存时间为1 ～38个月,1、2、3年累积无复发生存率分别为87.3％、82.8％和80.9％.多因素Cox比例风险回归模型分析发现,免疫抑制剂停药(x1)(β=0.940,Waldx2=12.018,P=0.001)、口服糖皮质激素停药(X2)(β=1.334,WaldX2=18.450,P＜0.001)、感冒(X3)(β=0.642,Wald x2=11.988,P=0.001)、工作学习紧张(X4)(β=0.285,Wald x2=4.925,P=0.026)、烟酒过度(X5)(β=0.541,Wald x2 =4.718,P=0.030)是葡萄膜炎患者复发的独立危险因素.葡萄膜炎患者复发风险函数模型为:h(t)=h0exp(2.559 X1+3.797 X2+1.901X3+1.331 X4+1.719 X5). 结论 葡萄膜炎患者复发是多因素影响的结果,规范化用药、改变不良生活和工作习惯可避免葡萄膜炎复发,针对可控因素进行干预是预防葡萄膜炎复发的有效措施.%Background Replase of uveitis is a primary cause of vision damage.To predict recurrentassociated factors for uveitis is very critical for the prevention and management of uveitis.Objective This study was to explore the risk factors of recurrent uveitis and establish the prediction model of recurrent uveitis.Methods Clinical data of recurrent uveitis patients who were diagnosed in Renhe Hospital of Three Gorges University from July 1,2010 to June 30,2011 were retrospectively reviewed.The demography characteristics of the patients were collected and the disease was followed-up under the informed consent.Kaplan-Meier method was used to estimate the disease recurrence rate and to plot relapse-free survival curve at different levels of predictive factors.Multivariate Cox proportional hazards model was used to select independent risk factors of relapse and establish the prediction model for recurrent uveitis.Results Total 825 cases of recurrent uveitis were included and followed up for 1 month to 38 months,with a median following-up time of 16 months.Relapse of uveitis was identified in 149 cases (18.1％)during the following-up duration.The relapse-free survival time was from 1 month to 38 months,and the 1-,2-and 3-year cumulative recurrence-free survival rates were 87.3％,82.8％ and 80.9％.Multivariate Cox proportional hazards regression analysis showed that immunosuppression withdrawal(X1) (β =0.940,Waldx2 =12.018,P =0.001),oral steroid withdrawal (X2) (β =1.334,Wald x2 =18.450,P ＜ 0.001),colds (X3) (β =0.642,Wald x2 =11.988,P =0.001),work and study stress(X4) (β=0.285,Wald x2 =4.925,P=0.026) and excessive alcohol and tobacco(X5) (3--0.541,Wald x2 =4.718,P =0.030) were the independent risk factors for recurrence of uveitis.The risk of recurrence in patients with uveitis function model expression was h (t)=h0 exp (2.559 X1 +3.797 X2 + 1.901 X3 + 1.331 X4 +1.719 X5).Conclusions Replase of uveitis is an interaction of many factors,and immunosuppression withdrawal,oral steroid withdrawal,colds,work and study stress,excessive alcohol and tobacco are independent risk factors for recurrence of uveitis.An intervention according to the controllable factors is one of the important ways to prevent the recurrence of uveitis.