云南省6个地区农村人群翼状胬肉患病率及其影响因素的研究

Prevalence and risk factors for pterygium in six rural regions of Yunnan Province

目的获取云南省6个地区12个民族40岁及以上农村人群的翼状胬肉患病率,并探讨其影响因素。方法横断面研究。采用多阶段分层抽样的方法于2019年3至11月在云南省楚雄彝族自治州、文山壮族苗族自治州、普洱市、德宏傣族景颇族自治州、迪庆藏族自治州和丽江市6个地区抽取12个民族(汉族、彝族、藏族、傈僳族、白族、纳西族、壮族、苗族、傣族、景颇族、哈尼族和拉祜族)40岁及其以上农村人群样本,对目标人群进行现场调查问卷,依据手持裂隙灯显微镜检查结果诊断翼状胬肉并对其分级,用手持裂隙灯显微镜进行眼前节检查,用直接检眼镜进行眼后节检查。检查结果采用二分类两水平模型,以民族为高水平、个体为低水平,并将地理气候信息采用主成分分析,研究地区、民族、性别、年龄、职业、是否户外活动、吸烟和饮酒等因素对翼状胬肉患病率的影响。两组计量资料的比较采用独立样本t检验或Wilcoxon秩和检验;计数资料的比较采用卡方检验或Fisher确切概率法;等级资料的比较采用Wilcoxon秩和检验。多组资料的比较采用Kruskal-Wallis H检验。趋势检验采用χ^(2)检验。多因素分析用Logistic回归分析。相关分析用Spearman秩相关分析。结果共纳入受检者9617人,其中女性6568人(68.3%),男性3049人(31.7%);年龄(61.86±11.35)岁。检出翼状胬肉患者2173例,患病率为22.6%;用云南省统计局的数据按年龄和性别同时进行校正后患病率为19.6%。校正后文山壮族苗族自治州翼状胬肉患病率最高(29.4%),楚雄彝族自治州次之(24.4%),迪庆藏族自治州和普洱市均为17.5%,丽江市(15.7%)和德宏傣族景颇族自治州(15.8%)偏低,各地区的差异有统计学意义(χ^(2)=146.50,P<0.001)。单因素回归分析结果显示,年龄、性别、民族、地区、吸烟史、饮酒史、饮食习惯、每日睡眠时间、是否连续使用滴眼液、温度、湿度、海拔、经度、纬度、紫外线是翼状胬肉患病的影响因素。多因素回归分析结果显示,影响翼状胬肉患病的主要危险因素有女性[比值比(OR)=1.357,95%置信区间(CI):1.173~1.568]、高龄(OR=1.540,95%CI:1.301~1.823)、地区(OR=1.713,95%CI:1.100~2.667)、连续使用滴眼液(OR=1.177,95%CI:1.034~1.340)、饮酒史≥40年(0R=1.525,95%CI:1.108~2.099),保护因素为吸烟史≥40年(OR=0.723,95%CI:0.544~0.960)。结论云南省6个地区农村人群按年龄和性别校正后的翼状胬肉患病率为19.6%。各地区之间翼状胬肉发病率差异较大,影响翼状胬肉患病的主要因素有性别、年龄、地区、吸烟史和饮酒史。

Objective To investigate the prevalence and risk factors of pterygium in the rural population aged 40 years and above of 12 ethnic groups in 6 regions of Yunnan Province.Methods This was a cross-sectional study.According to the method of multistage stratified sampling,samples of the rural population aged 40 years and above were collected from 12 ethnic groups(Han,Yi,Tibetan,Lisu,Bai,Naxi,Zhuang,Miao,Dai,Jingpo,Hani,and Lahu)in six areas(Diqing,Lijiang,Wenshan,Dehong,and Pu′er)of Yunnan Province from March 2019 to November 2019.Anterior segment examination was carried out in the target population with a hand-held slit-lamp,according to which pterygium was diagnosed,while the posterior segment of the eye was assessed by direct ophthalmoscopy.A field questionnaire survey was also conducted.A two-level model was used to study the effects of the location,nationality,sex,age,occupation,outdoor activities,smoking,and alcohol consumption on the prevalence of pterygium,with the ethnic group as the high level and the individual as the low level.Results Among 9617 subjects,the total prevalence rate of pterygium was 22.6%,which was adjusted to 19.6%according to the age and gender data of the Statistics Bureau of Yunnan Province.There was significant difference in prevalence of pterygium among six regions after adjusting for age and sex(χ^(2)=146.50,P<0.001).The prevalence of pterygium was the highest in Wenshan(29.4%),followed by Chuxiong(24.4%),Diqing(17.5%),Pu′er(17.5%),Dehong(15.8%),and Lijiang(15.7%)(χ^(2)=146.50,P<0.001).The results of the single factor analysis showed that there was statistically significant difference among different groups of age,gender,nationality,location,history of smoking,drinking,eating habits,sleeping time,continuous use of eye drops,temperature,humidity,altitude,longitude,latitude,and ultraviolet ray(P<0.05).However,the results of the multivariate analysis showed that the main risk factors of pterygium were female(OR=1.357,95%CI:1.173~1.568),advanced age(OR=1.540,95%CI:1.301~1.823),location(OR=1.713,95%CI:1.000~2.667),continuous use of eye drops(OR=1.177,95%CI:1.034~1.340),and more than 40 years of alcohol drinking(OR=1.525,95%CI:1.108~2.099),and the protective factor was more than 40 years of smoking(OR=0.723,95%CI:0.544~0.960).Conclusions The prevalence of pterygium varies greatly among different regions in Yunnan Province.The main factors affecting the prevalence are sex,age,region,smoking history,and drinking history.