年轻闭角型青光眼住院患者临床特征分析  

Clinical features of young inpatients with angle-closure glaucoma

作　　者：林树芬[1] 肖辉[1] 陈立明 凌运兰[1] 魏伟 方蕾 苏毅华 骆静怡 刘杏[1] Lin Shufen;Xiao Hui;Chen Liming;Ling Yunlan;Wei Wei;Fang Lei;Su Yihua;Luo Jingyi;Liu Xing(Zhongshan Ophthalmic Centre,Sun Yat-sen University,State Key Laboratory of Ophthalmology,Guangzhou 510060,China)

机构地区：[1]中山大学中山眼科中心眼科学国家重点实验室,广州510060

出　　处：《中华眼科杂志》2022年第1期28-34,共7页Chinese Journal of Ophthalmology

基　　金：广东省自然科学基金(2017A030313649);眼科学国家重点实验室专项(3030901010093);中山大学临床医学研究5010计划(2014016)。

摘　　要：目的探讨年轻的闭角型青光眼住院患者的病种构成,并比较原发性闭角型青光眼(PACG)与继发性闭角型青光眼(SACG)的临床特征。方法回顾性病例系列研究。连续收集2012年1月至2019年12月于中山大学中山眼科中心就诊的发病年龄≤40岁的闭角型青光眼住院患者资料,记录患者入院诊断、性别、发病年龄,收集患者常规眼科检查及A型超声波测定、超声生物显微镜、相干光层析成像术及视野检查的结果。分析PACG与SACG所占比例、病种构成,比较两类患者的发病年龄、视力、视野、眼球生物学结构参数及初诊误诊率。非正态分布资料以M(Q1,Q3)表示。统计学比较采用Mann-Whitney U检验、χ2检验及独立样本t检验。结果共纳入243例(243只眼)患者,发病年龄(28±9)岁;男性与女性比例为1∶1.79;其中PACG患者93例(38.3%),SACG患者150例(61.7%)。PACG患者年龄[34(28,38)岁]及男性比例[22.6%(21/93)]与SACG患者[28(19,34)岁,44.0%(66/150)]比较,差异均有统计学意义(Z=-5.34,χ^(2)=11.46;均P<0.01)。SACG患者中以真性小眼球(22.7%,34例)、常染色体隐性遗传卵黄样蛋白病(ARB)(19.3%,29例)、葡萄膜炎(18.7%,28例)、视网膜色素变性(14.0%,21例)较为多见。PACG和SACG患者的最佳矫正视力(最小分辨角对数视力)分别为0.10(0.00,0.48)、0.40(0.06,1.00),视野平均缺损值分别为-8.07(-27.49,-2.09)、-15.04(-28.75,-5.97)dB,黄斑中心凹下脉络膜厚度分别为(452.3±130.7)、(396.3±120.9)μm,两类患者间差异均有统计学意义(Z=-4.86,-2.14;t=2.37;均P<0.05)。PACG与SACG患者的眼压、视杯与视盘直径比、前房角粘连范围、中央前房深度、晶状体厚度、视网膜神经纤维层厚度差异无统计学意义(均P>0.05)。所有患者初诊误诊率为10.7%(26/243),其中SACG患者的误诊率为16.7%(25/150),高于PACG患者的1.1%(1/93)(χ^(2)=14.61,P<0.001)。结论年轻闭角型青光眼住院患者以PACG以及SACG中的真性小眼球、ARB为Objective To analyze the composition of diagnosis in young inpatients with angle-closure glaucoma and to compare the clinical characteristics between primary angle-closure glaucoma(PACG)and secondary angle-closure glaucoma(SACG).Methods This was a retrospective case series study.Angle-closure glaucoma patients aged 40 years or younger and hospitalized in Zhongshan Ophthalmic Center from January 2012 to December 2019 were included.The clinical diagnosis,gender,onset age,and results of general ophthalmic examination,A-scan ultrasonography measurements,ultrasound biomicroscopy,optical coherence tomography and visual field were recorded.The proportions and composition of PACG and SACG,as well as the misdiagnosis ratio,were analyzed.The onset age,visual acuity,visual field,and ocular parameters were compared between patients with PACG and SACG.Non-normally distributed data were represented by M(Q1,Q3).The difference between groups were compared by Mann-Whitney U test,Chi square test,and independent sample t test.Results A total of 243 patients(243 eyes)were included in this study.The mean onset age was(28±9)years,and the male-to-female ratio was 1∶1.79.There were 93 patients(38.3%)in PACG group and 150(61.7%)in SACG group.The age of PACG[34(28,38)]was older than that of SACG[28(19,34)],and the proportion of males in the SACG group(44.0%,66/150)was significantly higher than that in the PACG group(22.6%,21/93)(Z=-5.34,χ2=11.46;both P<0.01).Nanophthalmos(22.7%,34 cases),autosomal recessive bestrophinopathy(ARB)(19.3%,29 cases),uveitis(18.7%,28 cases)and retinitis pigmentosa(14.0%,21 cases)were the most common causes of SACG.The best corrected visual acuity(logarithm of the minimum angle of resolution)was 0.10(0.00,0.48)and 0.40(0.06,1.00),mean deviation of visual field was-8.07(-27.49,-2.09)and-15.04(-28.75,-5.97)dB,and subfoveal choroidal thickness was(452.3±130.7)and(396.3±120.9)μm in the PACG and SACG groups,respectively.The differences were statistically significant(Z=-4.86,-2.14;t=2.37;all P<0.05).There was n

关 键 词：青光眼 闭角型 住院病人 眼前半段 轴长度 眼 青年人 

分 类 号：R775.2[医药卫生—眼科]