北京地区50岁以上人群及糖尿病和青光眼患者的脉络膜厚度及其影响因素

Subfoveal choroidal thickness of Chinese aged over 50 years and patients with diabetes mellitus and glaucoma

目的：探讨人群黄斑中心凹下脉络膜厚度（ SFCT ）的分布及影响因素；分析糖尿病及糖尿病视网膜病变、青光眼等相关疾病与脉络膜厚度的关系。方法以人群为基础的横断面研究，数据来源于“北京眼病研究2011”。包括3468名参与者，平均年龄（64.6±9.8）岁。对参与者进行系统眼科检查，并采用谱域相干光断层深度增强扫描（ EDI SD-OCT）测量脉络膜厚度。分析纳入糖尿病患者246例，青光眼患者128例。计算人群平均SFCT及相关疾病患病率；单因素及多因素线性回归分析SFCT的眼部及全身危险因素。结果人群平均SFCT为（253.8±107.4）μm。使用多因素回归分析与SFCT相关的因素包括：低龄（b＝-4.12， P＜0.001）、眼轴长度短（b＝-44.7， P＜0.001）、男性（b＝-28.5， P＜0.001）、前房深度（b＝39.3， P＜0.001）、晶状体厚度（b＝26.8， P＜0.001）、角膜曲率（b＝46.0， P＜0.001）及BCVA（b＝-48.4， P＝0.001）。糖尿病组平均SFCT 为（266±108）μm。多因素分析示SFCT与确诊糖尿病显著相关（b＝21.2， P＝0.001），但与糖尿病视网膜病变（ P＝0.61）及糖尿病视网膜病变的级别（ P＝0.14）均无显著相关性。青光眼组平均 SFCT 为（201.4±102.4.1）μm，其中开角型青光眼为（210.1±104.7）μm， PACG为（184.2±93.6）μm。多因素分析SFCT与闭角型青光眼显著相关（ b＝-32.3， P＝0.04）；而与开角型青光眼无显著相关（ P＝0.44）。结论本研究人群平均SFCT为（253.8±107.4）μm。 SFCT随年龄和近视屈光度数的增加而下降，并且与男性、前房深度、晶状体厚度及BCVA相关。糖尿病人群的SFCT较健康人稍厚，但糖尿病视网膜病变的发生及发展并不能加重脉络膜的改变。闭角型青光眼的SFCT较健康人薄，而开角型青光眼的SFCT与健康人无明显差异。（中华眼科杂志，2014，50：414-420）

Objective To investigate the subfoveal choroidal thickness （ SFCT ） and its relationship to associated diseases , including diabetes mellitus , diabetic retinopathy , and glaucoma.Methods The population-based cross-sectional Beijing Eye Study 2011 included 3 468 individuals with a mean age of （64.6 ±9.8 ） years.A detailed ophthalmic examination was performed including spectral-domain optical coherence tomography with enhanced depth imaging model （EDI SD-OCT）.246 patients with diabetes and 128 patients with glaucoma were enrolled in the study.Statistical analysis was performed by SPSS 20.0 to examined the mean values of SFCT and the prevalence rate of associated diseases ; an univariate and multivariate linear regression to analyse the relationship between SFCT and ocular or general factors .Results Mean SFCT was （ 253.8 ±107.4 ）μm.In multivariate analysis , SFCT was significantly associated with younger age（b=-4.12, P〈0.001）, shorter axial length（b=-44.7, P〈0.001）, male gender（b=-28.5, P〈0.001）, deeper anterior chamber depth （b=39.3, P〈0.001）, thicker lens（b=26.8, P〈0.001）, flatter cornea（b=46.0, P〈0.001） and better best corrected visual acuity （b=-48.4, P=0.001）.Mean SFCT in diabetes mellitus group was （266 ±108） μm.In multivariate analysis, SFCT was significantly related to presence of diabetes mellitus （b=21.2, P=0.001）; but neither presence （P=0.61） nor stage （P=0.14） of diabetic retinopathy was significantly associated with SFCT.Mean SFCT in glaucoma group was （201.4 ±102.4.1） μm.Mean SFCT in glaucoma group was （201.4 ±102.4.1） μm;for open angle glaucoma , mean SFCT was （ 210.1 ±104.7 ） μm; for primary close angle glaucoma , mean SFCT was （184.2 ±93.6 ）μm.In multivariate analysis, SFCT was significantly associated with close angle glaucoma（b=-32.3, P=0.04）, but was not related to open angle glaucoma （P=0.44）.Conclusions Mean SFCT was （ 253.8 ±107.4 ）μm.SFCT was increased with age and myopic refractive error; and associated with male gender , anterior chamber depth , lens thickness , flatter cornea , best corrected visual acuity.SFCT in patients of diabetes mellitus was slightly thicker than normal people ; but the presence and development of diabetic retinopathy were not related to SFCT.SFCT in patients with close angle glaucoma was thinner than control group;but for open angle glaucoma , SFCT was similar to the normal people.