陕西农村50岁以上人群眼压不对称性与无确诊史青光眼相关研究

Observation study on the relationship between the asymmetry of intraocular tension and glaucoma without previous diagnosis and treatment in Shaanxi rural people aged above 50

目的:通过对陕西省农村50岁以上人群眼压(IOP)不对称性的分布情况及其与无确诊史的调查,分析眼压不对称性与原发性青光眼之间的关系。方法:采用分层整群抽样法于2003-07/12在陕西省洋县、靖边县及富平县对50岁以上人口进行问卷调查,包括询问青光眼确诊史、家族史、发作史和手术史,并进行相关眼科检查,包括视力、眼压、外眼、眼前节、前房深度、眼底等,可疑青光眼者进行进一步检查,包括复查眼压、检查前房角、进行激发试验、检查视野等。双眼眼压之差≥3mmHg定义为眼压不对称性。服用抗青光眼药物者、有诊断史的青光眼患者、接受过白内障手术者及有不可信眼压的受检者不做为调查对象。结果:共调查50岁以上观察对象2125例,其中有1775例完成了青光眼的相关检查,受检率为83.53%。在排除了83例服用抗青光眼药物或有青光眼诊断史、或曾接受过白内障手术及眼压不可信的受检者后,共有1692例符合研究对象纳入标准。调查发现共有23例无青光眼确诊史的患者,患病率为1.36%(95%CI,0.88,2.07)。眼压不对称性共有124例,患病率为7.3%(95%CI,6.2,8.7)。通过Mantel-Haenszel分层分析,显示眼压不对称性的患病率随年龄的增长而显著增加(P=0.012)。双眼中最高眼压>21mmHg的受检者眼压不对称性的患病率(35.7%)明显高于最高眼压≤21mmHg的受检者(7.1%)。应用多因素非条件logistic回归分析显示眼压不对称性与无确诊史的原发性青光眼有显著性关联(OR为3.68;95%CI,1.37,9.86),此联系在双眼中的最高眼压≤21mmHg的受检者中依旧保持(OR为4.74;95%CI,1.16,19.35)。结论:对于那些没有出现高眼压并且还未诊断为青光眼的患者,眼压不对称性与原发性青光眼关联有统计学意义,提示临床上诊断原发性青光眼时,眼压不对称性可作为一个有价值的诊断参考指征。

AIM： To investigate the asymmetrical distribution of lOP in a rural population in Shaanxi province and review the relationship between it and glaucoma without previous diagnosis. METHODS： By using a stratified cluster random sampling technique, total 2 125 persons aged above 50 years were draw-out from Yang County, Jingbian County and Fuping County in Shaanxi province during the period of July to December in 2003. All participants had an interview with a standard questionnaire, including questions related to glaucoma of previous diagnosis and treatment, family history, the onset history and history of operation. At the same time, a detailed and relative eye examination was performed, including visual acuity, the intraocular pressure, external eye examination, anterior segment of eye, peripheral anterior chamber depth, fundus examination and so on. A further examination was performed to these persons with suspicious glaucoma, including repeated tonometric examination, gonioscopy, provocative test, automated visual field testing, etc. When the difference of bilateral IOP≥3mmHg was defined as asymmetrical intraocular tension. Cases with patients after cataract operation, glaucoma with previous diagnosis and treatment and person with unconfirmed lOP were excluded. RESULTS： Total 1 775 participants were more than 50 years old, a response rate of 83. 53%, in which 83 participants were excluded because they accepted cataract operation, received previous glaucomatous diagnosis and treatment and had unconfirmed lOP in the past. Eventually, 1 892 participants corresponded to the analytical standard. In this population, 23 participants were not found the previous diagnosis of glaucoma, the prevalence was 1.38% [ 95% confidence interval （ CI）, 0. 88-2. 07 l, 124 participants were found to have the asymmetry of intraocular tension, the prevalence was 7. 3% （95% CI, 8.2-8.7）. With ManteI-Haenszel analyses, the prevalence of the asymmetry of intraocular tension was increasing obviously with aging （P = 0. 012）. The prevalence of subjects with the asymmetry of intraocular tension whose the highest IOP 〉 21mmHg was 35.7%, which was higher than that for subjects whose the highest IOP≤21mmHg （7.1%）. With multiple logistic analyses, the asymmetry of intraocular tension has conspicuous association with glaucoma without definite diagnosis （OR：3.88, 95% CI, 1.37-9.88）, and this relationship was also existed in subjects whose the highest IOP~〈21mmHg （OR：4.74, 95%CI, 1.18- 19.35）. CONCLUSION： To normal tension glaucoma without definite diagnosis, the asymmetry of intraocular tension may become an useful diagnostic indication.