新型冠状病毒Omicron变异株流行期间原发性闭角型青光眼就诊情况单中心研究

Clinical presentation of acute primary angle-closure glaucoma during the 2019-nCoV epidemic of Omicron variants:a single-center retrospective study

目的探讨近3年新型冠状病毒(新冠)流行期间原发性闭角型青光眼(PACG)急性发作就诊人数变化特点及其与广东省新冠Omicron变异株感染之间的关系。方法生态学研究。回顾性连续纳入2020年2月至2023年1月在中山大学中山眼科中心因PACG急性发作就诊患者的临床资料,按照就诊日期分为2020年组(2020年2月1日至2021年1月31日)、2021年组(2021年2月1日至2022年1月31日)和2022年组(2022年2月1日至2023年1月31日),收集基本临床资料、疾病史及新冠感染情况。从中国疾病预防控制中心获取广东省新型冠状病毒核酸检测阳性数据。重点观察每周PACG急性发作就诊人数,2022年12月至2023年1月(广东省新冠Omicron变异株流行期间)PACG急性发作就诊人数及占比、发病特点、变化趋势及其与广东省每日新冠感染新增人数的相关性。本研究采用方差分析、Bonferroni法、Kruskal-Wallis H检验、Fisher精确检验、Spearman相关性分析进行统计学分析。结果共纳入1048例PACG急性发作患者资料,其中2020年组235例,2021年组274例,2022年组539例。2022年组每周PACG急性发作就诊人数为8(5,11)例,显著大于2020年组[(4.52±1.95)例,P<0.05]和2021年组[(5.27±2.76)例,P<0.05]。在2022年组中,2022年12月1日至2023年1月31日PACG急性发作就诊人数为199例,占2022年组36.9%,是2020年组和2021年组同期(12月1日至次年1月31日)的6.63和6.42倍,每周PACG急性发作就诊人数为(22.11±20.84)例;3个组同期双眼发病患者比例和发病至就诊间隔时间比较,差异均有统计学意义(P<0.05)。在2022年组中接受电话随访的123例患者中,109例(88.6%)患者在急性发作前2(0,3)d有新冠感染相关病史。每日PACG急性发作人数自2022年12月增加,至12月23日达到高峰,然后逐渐减少,与广东省同期每日新冠核酸检测阳性新增人数趋势相似。每日PACG急性发作人数与每日新冠核酸检测阳性新增人数呈正相关(r=0.84,P<0.001)。结论2022年12月至2023年1月广东省新冠Omicron变异株流行期间,中山大学中山眼科中心出现3年来最大PACG急性发作就诊高峰,与广东省新冠感染趋势存在时间方面的相关性,确切原因仍有待深入探讨。

Objective To investigate the clinical presentation pattern of acute primary angle-closure glaucoma(PACG)during the 2019 novel coronavirus(2019-nCoV)pandemic over the past three years,and its relationship with 2019-nCoV infections of Omicron variants in Guangdong province.Methods Ecological study.Patients who were newly diagnosed with acute PACG from February 2020 to January 2023 at the Zhongshan Ophthalmic Center of Sun Yat-sen University were included in the study,and their basic information was collected.Patients were divided into the 2020 group(diagnosed between February 1st,2020 and January 31st 2021),the 2021 group(diagnosed between February 1st,2021 and January 31st 2022),and the 2022 group(diagnosed between February 1st,2022 and January 31st 2023).The clinical presentation pattern of newly diagnosed acute PACG was observed and compared between groups.The daily number of newly diagnosed 2019-nCoV infections in Guangdong province was obtained from the Chinese Center for Disease Control and Prevention.The correlation between the daily number of newly diagnosed acute PACG and that of newly diagnosed 2019-nCoV infections during the epidemic period of Omicron variants between December 2022 and January 2023 was assessed.Results The study included 1048 patients with newly diagnosed acute PACG,with 235 for the 2020 group,274 for the 2021 group,and 539 for the 2022 group.Our results showed that the average weekly number of newly diagnosed acute PACG patients in 2022[8(5,11)]was significantly larger than that in 2020(4.52±1.95,P<0.05)and 2021(5.27±2.76,P<0.05).The average weekly number increased to 22.11±20.84 between December 2022 and January 2023.The total number of newly diagnosed acute PACG patients during this period was 199,which was 36.9%(199/539)of the total number of the same year and was 6.63 and 6.42 times as many as that in the same period(December and January)of 2020 and 2021.The proportion of patients with bilateral eye involvement during this period in 2022 was significantly higher than that in 2020 and 2021(P<0.05).Further analysis found that 88.6%(109/123)of cases had a history of 2019-nCoV infection 2(0,3)days before the onset of acute PACG symptoms in average.The estimated daily number of acute PACG onset increased rapidly,peaked on December 23th,2022,and then dropped gradually.This trend was similar to that of the daily number of new 2019-nCoV infections in Guangdong province.Changes of the daily number of new 2019-nCoV infections in Guangdong province had a positive correlation with the estimated daily number of acute PACG onset(r=0.84,P<0.001).Conclusion A dramatic increase in the clinical presentation of acute PACG was observed at Zhongshan Ophthalmic Center between December 2022 and January 2023,which was the epidemic period of Omicron variants.There is a correlation between the trend of the estimated daily number of acute PACG onset and that of new 2019-nCoV infections of Omicron variants in Guangdong province,but the exact reason remains to be further studied.