高原地区藏族年龄相关性黄斑变性相关危险因素分析及诺莫预测模型建立

Risk factors analysis of age-related macular degeneration in Tibetan of plateau area and establishment of nomogram prediction model

目的了解高原地区藏族年龄相关性黄斑变性(AMD)的患病率及相关危险因素,并建立诺莫预测模型。方法采用横断面调查研究设计和整群随机抽样的方法,于2019年6—12月由青海省人民医院组织、兴海县人民医院和同德县人民医院共同参与,对平均海拔约3000 m的兴海县、同德县≥40岁藏族人群进行问卷调查、眼部常规检查、直接眼底照相和健康宣教。问卷调查内容包括年龄、性别、是否吸烟、是否饮酒、高原地区居住时长、每天日照时长、糖尿病、高血压、高血脂等一般情况。采用χ^(2)检验筛选有显著差异的因素,并采用Logistic回归分析筛选AMD的相关危险因素,采用R软件绘制AMD预测诺莫图并对预测模型进行准确性验证。结果本次调查实际受检人数为1223人,检出AMD患者190例,AMD患病率为15.54%。高龄、高原地区居住时长、日照时长、吸烟、高血压、高血脂是AMD的相关危险因素。其中高龄是AMD的高危因素(OR=20.183,95%CI:9.536~29.805,P<0.001),其次是日照时长(OR=3.785,95%CI:1.581~8.721,P<0.001)。诺莫预测模型显示,当评分>150分时,患者可能出现AMD的概率为50%。决策曲线表明,当阈概率>25%时,预测发生AMD的概率与实际AMD发生率一致。结论高龄、久居高原地区、长时间日照、吸烟、高血压和高血脂是AMD的危险因素,尤其要注意长时间居住在高原地区并且阳光暴露时间长的高龄人群。

Objective To determine the prevalence and risk factors for age-related macular degeneration(AMD)in Tibetan of plateau area,and to establish a nomogram prediction model.Methods A cross-sectional study was carried out.The 40-year-old and older Tibetan subjects were enrolled by cluster random sampling from Xinghai County and Tongde County with an average altitude of 3000 meters in Qinghai Province.Questionnaire survey,routine ophthalmic examinations,direct fundus photography and health education were carried out among the subjects.The questionnaire items included age,gender,smoking,drinking,living duration in plateau region,daily sunshine duration,diabetes,hypertension and hyperlipidemia.Aχ^(2) test was used to screen significantly factors,and risk factors for AMD were analyzed by logistic regression analysis.The nomogram plot was drawn by R software to establish a predicting model.The study protocol adhered to the Declaration of Helsinki and was approved by an Ethics Committee of Qinghai Provincial People's Hospital(No.2017-21).Written informed consent was obtained from each subject prior to any medical examination.Results A total of 1223 subjects were enrolled,and AMD were detected in 190 subjects with an prevalence of 15.54%.The risk factors for AMD were old age,living duration in plateau region,sunshine duration,smoking,hypertension and hyperlipidemia.Age was the first one of risk factors for AMD(OR:20.183,95%CI:9.536-29.805,P<0.001),followed by sunshine duration(OR:3.785,95%CI:1.581-8.721,P<0.001).The nomogram prediction model showed that when the questionnaire score was>150,the probability of suffering AMD was 50%.The decision curve showed that when the threshold probability was>25%,the predicted probability of AMD was the same as the actual probability.Conclusions Pathogesis of AMD in Tibet is associated with old age,living duration in plateau area,sunshine duration,smoking,hypertension and hyperlipidemia.