人外周血脂质水平和炎症指标与原发性开角型青光眼的关联性

Association between human peripheral blood lipid levels and inflammatory indicators in patients with primary open angle glaucoma

目的探讨外周血脂质水平和炎症指标与原发性开角型青光眼(POAG)的相关性。方法采用病例对照研究, 收集2016年1月至2022年3月于汕头大学·香港中文大学联合汕头国际眼科中心确诊为POAG的86例患者作为POAG组, 同时收集年龄、性别、体质量指数相匹配的86例单纯年龄相关性白内障患者作为对照组。采用Goldmann压平式眼压计测量眼压;采用Humphrey视野分析仪测量视野平均缺损(MD)。采集各组受试者外周静脉血, 使用全自动生化分析仪检测总胆固醇、总甘油三酯、高密度脂蛋白(HDL)、低密度脂蛋白(LDL)和C反应蛋白表达水平。使用全自动血液分析仪检测白细胞、中性粒细胞、淋巴细胞、单核细胞表达水平。筛选2个组间差异有统计学意义的指标作为自变量, 采用多重Logistic回归分析POAG的危险因素。采用Pearson线性相关分析确定各危险因素与POAG患眼眼压及MD之间的相关性。结果 POAG组HDL水平为(1.59±0.42)mmol/L, 明显低于对照组的(1.76±0.50)mmol/L, 差异有统计学意义(t=2.435, P=0.016)。POAG组LDL水平为(3.34±0.66)mmol/L, 明显高于对照组的(3.08±0.71)mmol/L, 差异有统计学意义(t=2.520, P=0.013)。POAG组白细胞水平为(6.91±1.60)×109/L, 明显高于对照组的(6.11±1.29)×109/L, 差异有统计学意义(t=3.619, P<0.001)。多重Logistic回归分析结果显示, 外周血LDL水平升高(P=0.039, OR=2.354, 95%CI:1.105~5.303)和白细胞水平升高(P=0.044, OR=1.310, 95%CI:1.007~1.703)是POAG发病的危险因素。Pearson相关分析发现, POAG患者外周血LDL和白细胞水平均与眼压呈中等强度正相关(r=0.610, P<0.001;r=0.358, P=0.001);LDL水平与MD呈中等强度负相关(r=-0.496, P<0.001), 白细胞水平与MD呈弱负相关(r=-0.235, P=0.030)。结论外周血LDL和白细胞水平升高是POAG患病的危险因素, 并与POAG患者眼压呈正相关, 与MD呈负相关。

Objective To investigate the association between serum lipid levels and inflammatory indicators in patients with primary open angle glaucoma(POAG).Methods A case-control study was conducted.A total of 86 POAG subjects were collected as a POAG group at Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong from January 2016 to March 2022.Meanwhile,86 with age-related cataract only,matched at age,sex and body mass index were collected as a control group.The intraocular pressure(IOP)and the mean defect of visual field(MD)were measured by Goldmann tonometer and Humphrey field analyzer,respectively.Human peripheral blood samples collected from subjects for serum lipid levels,including total cholesterol,total triglycerides,high density lipoprotein(HDL),and low density lipoprotein(LDL),were analyzed using an automated hematology analyzer and inflammatory markers including C-reactive protein,white blood cells(WBC),neutrophils,lymphocytes,monocytes,were analyzed using an automated biochemical analyzer.Indicators with statistically significant differences between the two groups were selected as independent variables,and multiple logistic regression analysis was used to determine the risk factors for POAG.Correlations between risk factors and ocular parameters(IOP and MD)were assessed using Pearson correlation analysis.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Joint Shantou International Eye Center of Shantou University and the Chinese University of Hong Kong(No.EC20210313[2]-P03).Written informed consent was obtained from each patient before any medical examination.Results The HDL was(1.59±0.42)mmol/L in the POAG group,which was significantly lower than(1.76±0.50)mmol/L in the control group(t=2.435,P=0.016).The LDL was(3.34±0.66)mmol/L in the POAG group,which was significantly higher than(3.08±0.71)mmol/L in the control group(t=2.520,P=0.013).The WBC was(6.91±1.60)×109/L in the POAG group,which was significantly higher than(6.11±1.29)×109/L in the control group(t=3.619,P<0.001).Multiple logistic regression analysis showed that high serum LDL level(P=0.039,OR=2.354,95%CI:1.105-5.303)and high WBC level(P=0.044,OR=1.310,95%CI:1.007-1.703)were risk factors for POAG.Pearson correlation analysis showed that the serum LDL and WBC levels of POAG patients were moderately positively associated with IOP(r=0.610,P<0.001;r=0.358,P=0.001).LDL level was moderately negatively associated with MD(r=-0.496,P<0.001).WBC level was weakly negatively associated with MD(r=-0.235,P=0.030).Conclusions The elevated peripheral blood LDL and WBC levels are risk factors for POAG onset.The elevated LDL and WBC levels are positively correlated with IOP and negatively correlated with MD in POAG patients.