内蒙古包头地区原发性闭角型青光眼患者生活质量调查及影响因素分析

Analysis of life quality of primary angle-closure glaucoma patients and its influencing factors in Baotou region, Inner Mongolia

目的调查内蒙古包头地区原发性闭角型青光眼(PACG)患者视功能相关生活质量以及焦虑抑郁状况并分析其影响因素。方法采用横断面研究设计,连续收集2018年9月至2020年1月于包头朝聚眼科医院就诊的治疗后双眼随机3次非接触眼压值≤20 mmHg(1 mmHg=0.133 kPa)的PACG患者182例364眼,记录患者性别、年龄、婚姻状况、教育水平、月收入、治疗花费总额、青光眼治疗时间、手术及药物治疗史、最佳矫正视力(BCVA)、Humphrey视野指标以及美国国立眼科研究所视功能相关生活质量量表-25(NEI-VFQ-25)和医院焦虑抑郁量表(HADS)评分。年龄与VFQ-25评分的相关性采用Pearson相关分析;其他数据资料之间的相关性采用Spearman秩相关分析。采用多元逐步线性回归分析方法分别分析VFQ-25评分、HADS评分与上述分析中有统计学意义的影响因素之间的相关性。结果纳入患者的平均年龄为(59.75±8.43)岁。VFQ-25综合得分为68.59±14.43,HADS、焦虑亚量表(HADS-A)和抑郁亚量表(HADS-D)得分分别为16.00(12.00,20.00)、8.00(6.00,10.00)、8.00(6.00,10.00)。焦虑或抑郁状态(HADS-A或HADS-D评分>10分)患者占比分别为18.1%(33/182)和13.7%(25/182)。受试者年龄与视功能较好眼BCVA和视功能较差眼BCVA均呈正相关(r_(s)=0.36、0.29,均P<0.01),与损害较轻眼Humphrey视野平均缺损(MD)、损害较重眼MD、损害较轻眼VFI、损害较重眼VFI均呈负相关(r_(s)=-0.21、-0.23、-0.30、-0.23,均P<0.01)。VFQ-25评分与年龄、视功能较好眼BCVA、视功能较差眼BCVA均呈负相关(r_(s)=-0.32、-0.34、-0.48,均P<0.01),与损害较轻眼MD、损害较重眼MD、损害较轻眼VFI、损害较重眼VFI均呈正相关(r_(s)=0.37、0.45、0.38、0.46,均P<0.01)。HADS-A评分与损害较轻眼MD呈负相关(r_(s)=-0.20,P<0.01);HADS-D评分与视功能较差眼BCVA呈正相关(r_(s)=0.26,P<0.01),与损害较轻眼MD、损害较重眼MD、损害较重眼VFI均呈负相关(r_(s)=-0.21、-0.22、-0.22,均P<0.01);HADS评分与视功能较差眼BCVA呈正相关(r_(s)=0.22,P<0.01),与损害较轻眼MD、损害较重眼MD、损害较重眼VFI均呈负相关(r_(s)=-0.20、-0.20、-0.21,均P<0.01);VFQ-25评分与HADS-A评分、HADS-D评分、HADS评分均呈负相关(r_(s)=-0.41、-0.41、-0.45,均P<0.01)。经多因素分析,影响VFQ-25评分的因素包括年龄(P<0.01)、教育水平(P<0.01)、治疗花费总额(P<0.05)、视功能较好眼BCVA(P<0.05)和损害较重眼MD(P<0.01);影响HADS评分的因素包括性别(P<0.05)和VFQ-25评分(P<0.01)。结论内蒙古包头地区PACG患者视功能相关生活质量和焦虑或抑郁状态患者占比均较低。随着年龄增加,PACG患者视功能下降,视野损害程度加重,视功能相关生活质量下降,焦虑和抑郁程度加重。教育水平低、治疗花费总额高的患者视功能相关生活质量较差;女性患者更易出现焦虑和抑郁状态。

Objective To investigate vision-related quality of life,anxiety and depression in patients with primary angle-closure glaucoma(PACG)and the influencing factors in Baotou,Inner Mongolia.Methods A cross-sectional study was conducted.One hundred and eighty-two consecutive PACG patients(364 eyes)with intraocular pressure≤20 mmHg(1 mmHg=0.133 kPa)at 3 random times after treatment were enrolled in Baotou Chaoju Ophthalmic Hospital from September 2018 to January 2020.Gender,age,marital status,education level,monthly income,total treatment cost,glaucoma treatment time,surgery and drug treatment history,best corrected visual acuity(BCVA),Humphrey visual field index(VFI)and scores of the National Eye Institute Visual Function Questionnaire-25(NEI-VFQ-25)and Hospital Anxiety and Depression Scale(HADS)of patients were recorded.Pearson correlation analysis was used to analyze the correlation between age and composite VFQ-25 score.Spearman rank correlation analysis was used to analyze the correlation between other statistical data.Stepwise multivariate linear regression was used to analyze the correlation between composite VFQ-25 score,HADS score and statistically significant influencing factors above.This study protocol adhered to the Declaration of Helsinki,and was approved by an Ethics Committee of Beijing Tongren Hospital,Capital Medical University(No.TRECKY2015-30).Written informed consent was obtained from each subject.Results The mean age of subjects was(59.75±8.43)years.The mean composite VFQ-25 score was(68.59±14.43)points.The mean HADS,HADS-Anxiety(HADS-A)and HADS-Depression(HADS-D)scores were 16.00(12.00,20.00),8.00(6.00,10.00),8.00(6.00,10.00)points,respectively.The proportion of anxious(HADS-A score>10 points)and depressd(HADS-D score>10 points)patients was 18.1%(33/182)and 13.7%(25/182),respectively.Age was positively correlated with BCVA in eyes with better and worse vision(r_(s)=0.36,0.29;both at P<0.01),and it was negatively correlated with mean deviation(MD)of Humphrey visual field in the better-MD and worse-MD eyes,VFI of Humphrey visual field in the better-VFI and worse-VFI eyes(r_(s)=-0.21,-0.23,-0.30,-0.23;all at P<0.01).The composite VFQ-25 score was negatively correlated with age,BCVA in the eyes with better and worse vision(r_(s)=-0.32,-0.34,-0.48;all at P<0.01),and it was positively correlated with MD in the better-MD and worse-MD eyes,VFI in the better-VFI and worse-VFI eyes(r_(s)=0.37,0.45,0.38,0.46;all at P<0.01).The HADS-A score was negatively correlated with MD in the better-MD eye(r_(s)=-0.20,P<0.01).The HADS-D score was positively correlated with BCVA in the eyes with worse vision(r_(s)=0.26,P<0.01)and negatively correlated with MD in the better-MD and worse-MD eyes,and VFI in the worse-VFI eyes(r_(s)=-0.21,-0.22,-0.22;all at P<0.01).The HADS score was positively correlated with BCVA in the eyes with worse vision(r_(s)=0.22,P<0.01),and negatively correlated with MD in the better-MD and worse-MD eyes,and VFI in the worse-VFI eyes(r_(s)=-0.20,-0.20,-0.21;all at P<0.01).The composite VFQ-25 score was negatively correlated with mean HADS-A,HADS-D and HADS scores(r_(s)=-0.41,-0.41,-0.45;all at P<0.01).According to the multivariate analysis,the composite VFQ-25 score was related to age(P<0.01),education level(P<0.01),total treatment cost(P<0.05),BCVA in the eyes with better vision(P<0.05)and MD in the worse-MD eyes(P<0.01).The HADS score was related to gender(P<0.05)and the composite VFQ-25 score(P<0.01).Conclusions The vision-related quality of life and incidence of anxiety and depression are low in patients with PACG in Baotou region,Inner Mongolia.With age increasing,PACG patients suffer from declined visual function,increased visual field damage,reduced vision-related quality of life and raised anxiety and depression.The vision-related quality of life is poorer in patients with lower education level and higher total treatment cost.Female glaucoma patients are more likely to suffer from anxiety and depression.