圆锥角膜临床特征及其严重程度的影响因素分析  

Clinical features of keratoconus and influencing factors of disease severity

作　　者：朱梦 杨凯丽 徐丽妍 范棋 顾宇伟 王晴[2] 殷姗姗 庞辰久 赵东卿 任胜卫 Zhu Meng;Yang Kaili;Xu Liyan;Fan Qi;Gu Yuwei;Wang Qing;Yin Shanshan;Pang Chenjiu;Zhao Dongqing;Ren Shengwei(Zhengzhou University People's Hospital,Henan Provincial People's Hospital,Henan Eye Hospital,Zhengzhou 450003,China;Henan University People's Hospital,Henan Provincial People's Hospital,Henan Eye Hospital,Zhengzhou 450003,China)

机构地区：[1]郑州大学人民医院、河南省人民医院、河南省立眼科医院,郑州450003 [2]河南大学人民医院、河南省人民医院、河南省立眼科医院,郑州450003

出　　处：《中华实验眼科杂志》2023年第5期484-492,共9页Chinese Journal Of Experimental Ophthalmology

基　　金：国家自然科学基金青年科学基金项目(81200664);河南省自然科学基金面上项目(222300420536);河南省医学科技攻关计划省部共建重点项目(SBGJ202002028、SBGJ202102051);河南省中青年卫生健康科技创新杰出青年人才培养项目(YXKC2020023);河南省立眼科医院基础研究重点专项(20JCZD003)。

摘　　要：目的了解圆锥角膜患者的临床特征,并探究与圆锥角膜患者疾病严重程度相关的影响因素。方法采用横断面研究方法,纳入2019年1月至2021年12月于河南省立眼科医院圆锥角膜门诊确诊的原发性圆锥角膜患者908例1476眼。采用面对面问卷调查的方式收集患者的病史资料,通过综合验光仪测量屈光参数,使用非接触式眼压计测量眼压,并采用Dresden法计算眼压校正值。通过Pentacam HR获得患眼的角膜地形图参数。所有患者按照年龄(<21岁组,21~<31岁组,≥31岁组)和性别分别进行亚组临床特征分析。依据陡峭角膜曲率(Ks)将圆锥角膜严重程度分成轻度(Ks<48 D)、中度(48 D≤Ks<55 D)和重度(Ks≥55 D)。采用有序Logistic回归分析圆锥角膜严重程度的影响因素。结果908例圆锥角膜患者中,双眼患者622例,单眼患者286例。患者平均发病年龄为20(17,26)岁,平均就诊年龄为21(18,27)岁,男女比例为3.05∶1。其中,9.80%(89/908)的患者有变态反应性疾病史,25.55%(232/908)的患者合并全身其他疾病史,1.98%(18/908)的患者有圆锥角膜家族史;1476只患眼中,27.57%(407/1476)为重度圆锥角膜,61.94%(568/917)有揉眼史。球镜度、柱镜度、眼压、校正眼压、Ks、最薄点角膜厚度(TCT)、前表面高度(AE)、后表面高度(PE)中值分别为-4.00(-7.00,-1.75)D、-3.50(-6.00,-1.50)D、12.00(10.30,13.80)mmHg、15.40(13.60,17.00)mmHg、49.85(46.40,54.90)D、460.00(425.00,490.00)μm、21.00(13.00,34.75)μm、51.00(33.00,75.00)μm。<21岁组患眼球镜度数、眼压和校正眼压均低于21~<31岁组,柱镜度数高于21~<31岁组,TCT高于≥31岁组,差异均有统计学意义(均P<0.05)。与女性相比,男性患者发病年龄更小,球镜度数、眼压和校正眼压更低,柱镜度数、AE和PE值更高,差异有统计学意义(均P<0.05)。<21岁组中男性患者球镜度数和眼压较女性低,21~<31岁组中男性患者柱镜度数高于女性,差异均有统计学意义(均P<0.05)Objective To investigate the clinical characteristics of patients with keratoconus,and to explore the factors influencing keratoconus severity.Methods A cross-sectional study was performed.A total of 908 patients(1476 eyes)with primary keratoconus were enrolled in Henan Eye Hospital from January 2019 to December 2021.The medical history data of patients were collected by face-to-face questionnaire survey.Refractive parameters were measured by subjective optometry.Intraocular pressure(IOP)was measured by a non-contact tonometer,and corrected IOP was calculated by Dresden formula.Corneal topography parameters was obtained using Pentacam HR.The subgroup analysis of clinical characteristics of all patients was performed by age(<21 years,21~<31 years,≥31 years)and gender.Disease severity was graded based on steep keratometry(Ks),namely mild(Ks<48 D),moderate(48 D≤Ks<55 D)and severe(Ks≥55 D).The influencing factors of disease severity in keratoconus were analyzed by ordered Logistic regression.This study adhered to the Declaration of Helsinki.The study protocol was approved by the Ethics Committee of Henan Eye Hospital(No.HNEECKY-2019[5]).All subjects or guardians were informed of the purpose and significance of the study and written informed consent was obtained.Results Of the 908 patients,622 were with bilateral keratoconus and 286 were with unilateral keratoconus.The median age of onset was 20(17,26)years,and the median age of diagnosis was 21(18,27)years.The ratio of males to females was 3.05∶1.There were 9.80%(89/908)of the patients having a history of allergy,25.55%(232/908)having a history of other systemic diseases,and 1.98%(18/908)having a family history of keratoconus.Of the 1476 affected eyes,27.57%(407/1476)were diagnosed as severe keratoconus,and 61.94%(568/917)had a history of eye rubbing.The medians of sphericity,cylindricity,IOP,corrected IOP,Ks,thinnest corneal thickness(TCT),anterior corneal surface elevation(AE)and posterior corneal surface elevation(PE)were-4.00(-7.00,-1.75)D,-3.50(-6.00,-1.

关 键 词：圆锥角膜 临床特征 年龄 性别 疾病严重程度 

分 类 号：R772.2[医药卫生—眼科]