跨筛板压力差与青光眼相关关系的研究:邯郸眼病研究  

Trans-lamina cribrosa pressure difference and glaucoma: The Handan Eye Study

作　　者：张青[1] 王宁利[1] Jonas Jost B. 杨一佺 王亚星[1] 梁远波[3] 王凤华[1] 杨迪亚[1] 解晓斌[4] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁眼科中心北京市眼科研究所眼科学与视觉科学北京市重点实验室,100005 [2]德国鲁普雷希特卡尔斯海德堡大学附属曼海姆医学院眼科 [3]浙江温州医科大学附属眼视光医院,325000 [4]中国中医科学院附属眼科医院,北京100040

出　　处：《眼科》2016年第4期225-231,共7页Ophthalmology in China

基　　金：卫生部卫生行业公益专项研究基金(201002019)

摘　　要：目的评价中国农村成年人群估算跨筛板压力差(TLCPD)与青光眼视神经损害的相关关系。设计以人群为基础的横断面研究。研究对象中国农村30岁及以上成年人群。方法对邯郸眼病研究I期6830例30岁以上受试者进行问卷、全身及眼部检查和血液、尿液实验室检查。眼科检查包括:视力检查、验光、裂隙灯检查、眼压、视野、晶状体、眼底检查、散瞳下眼底视神经立体照相,眼部A超,HRT-Ⅱ等。利用HRT-Ⅱ获得视盘的全周参数;引入非侵入测量颅内压(CSFP)研究得出的CSFP估算公式:CSFP(mmHg)=0.44×体质指数(BMI)(kg/m^2)+0.16×舒张压(DBP)(mmHg)-18×年龄(岁)-1.91。TLCPD:眼压-估算的CSFP。单因素及多因素分析分析非青光眼人群及原发性开角型青光眼(POAG)人群中估算筛板压力差、估算CSFP与全身系统及眼部参数的相关关系;评价该人群青光眼患病或青光眼特征性视神经损害定量参数与筛板压力差的关系。主要指标POAG及原发性闭角型青光眼(PACG)患者估算CSFP,估算TLCPD。结果 6450人(87.5%)的血压、身高、体重数据可用于数据分析。原发性开角型青光眼(POAG)组及非青光眼组相比,POAG组估算CSFP明显偏低,眼压、估算TLCPD明显偏高(P<0.001)。多因素分析中,校准其他混杂因素,POAG患病分别与较高的TLCPD(P<0.001;β:0.08;B:4.12;95%CI:2.24,6.02)、较低的估算CSFP(P=0.01;β:-0.05;B:-2.37;95%CI:-4.23,-0.51)显著相关。将TLCPD与眼压置于同一模型中,POAG患病与TLCPD增高显著相关(P<0.001;OR:1.290;95%CI:1.204,1.383),而非眼压(P=0.321);盘沿面积与TLCPD相关(P=0.028;β:-0.034;B:-0.003;95%CI:-0.005^-0.000),眼压被剔除(P=0.398);原发性闭角型青光眼(PACG)患病与眼压显著相关(P=0.02;OR:1.38;95%CI:1.05,1.71),而非TLCPD(P=0.46)。结论与PACG相比,TLCPD与POAG患病及视神经损害的关联强于眼压。这表明较低的CSFP在POAG发病机制中可能起到重要作用。Objective To assess whether trans-lamina cribrosa pressure difference （TLCPD） is associated with glaucoma in a population-based setting. Design Population-based cross-sectional study. Participants 6830 Han people aged 30 years or older from 13 villages of Yongnian County were recruited. Methods All participants underwent questionare, comprehensive eye examinations and physical examinations, Ocular examination included measurement of visual acuity （VA）, intraocular pressure, anterior and posterior segment examinations, visual field testing, and anterior segment, fundus and optic disc photography/imaging. Physical examination included measurement of height and weight, blood pressure, electrocardiogram, glucose, lipid levels, urea nitrogen and creatinine etc. Optic disc parameters were obtained using HRT II. Based on a previous study with lumbar cerebrospinal fluid pressure （CSFP） measurements, CSFP was calculated as CSFP （mmHg）=0.44xBMI （kg/m2） ＋ 0.16xDBP （mmHg） -18xAge （Years） -1.91. TLCPD was intraocular pressure （IOP）-CSFP. The associations of systemic parameters, ocular parameters and TLCPD or CSFP were assessed using simple and multiple regression analysis. The relationship between TLCPD antl prevalence of POAG or the amount of glaucomatous damage were analyzed. Main Outcome Measures Presence of POAG, presence of primary, angle-closure glaucoma （PACG）, CSFP, TLCPD. Results Measure- ments of blood pressure, body height, and weight were available for 6450 （87.5%） subjects. In sixty-seven patients with prirnmy opeu-angle glaucoma （POAG） as compared with nou-glaucomatous individuals, estimated CSFP was lower （10.2±3.7 mmHg versus 12.0±3.4mmHg; P〈0.00I） and estimated TLCPD was higher （6.4±4.2mmHg versus 2.9±3.7mmHg; P〈0.001）. In multivariate analysis, higher cstimated TLCPD （P〈0.001; standardized correlation coefficient [3： 0.08; correlation coefficient B： 4.12; 95% Confidence Interval （CI）： 2.24, 6.02） and lower estimated CSFP （P=0.01;

关 键 词：眼压 视神经 青光眼 颅内压 跨筛板压力差 

分 类 号：R775[医药卫生—眼科]