基于心脑血管病筛查的极高海拔地区眼底特征谱的初步研究  

Preliminary study on fundus characteristics spectrum in extremely high-altitude areas based on cardiovascular and cerebrovascular disease screening

作　　者：米玛顿珠[1] 张瑞 王凡 王斌 季士勇 罗源 荣策 格桑罗布[2] 王丽平 Mimadunzhu;Zhang Rui;Wang Fan;Wang Bin;Ji Shiyong;Luo Yuan;Rong Ce;Wang Liping(Department of Neurology,Tibet Autonomous Region People's Hospital,Lhasa 850000,China;Institute of Plateau Cardiovascular Disease,Tibet Autonomous Region People's Hospital,Lhasa 850000,China;Medical College of Tibet University,Lhasa 850000,China;Beijing Eagle Pupil Science and Technology Development Co,Beijing 100084,China;Group Technology Department,Aikang Guobin Health Check-up Management Group Co,Beijing 100022,China;Department of Neurology,Peking University Third Hospital,Beijing 100191,China)

机构地区：[1]西藏自治区人民医院神经内科,拉萨850000 [2]西藏自治区人民医院高原心血管病研究所,拉萨850000 [3]西藏大学医学院,拉萨850000 [4]北京鹰瞳科技发展股份有限公司医学部,100084 [5]爱康国宾健康体检管理集团有限公司集团技术部,北京100022 [6]北京大学第三医院神经内科,100191

出　　处：《中华脑血管病杂志(电子版)》2024年第6期564-572,共9页Chinese Journal of Cerebrovascular Diseases(Electronic Edition)

基　　金：西藏自治区自然科学基金重点项目(XZ202101ZR0102G);西藏自治区组团式援藏医学项目[XZ2021ZRZY03(Z)]。

摘　　要：目的旨在通过对极高海拔地区(西藏自治区)眼底视网膜特征及发病率的筛查,进一步探讨其与心脑血管疾病之间的关联性。方法选择长期居住在西藏自治区那曲市极高海拔(海拔4500 m以上)的3个县(尼玛县、双湖县、安多县)的8个乡镇51个村庄的2712例藏族居民进行调查,以平原地区1919301例健康体检人群数据作为对照。采用日本佳能免散瞳眼底照相机CR-2AF,在自然瞳孔状态下对目标人群进行眼底照相,详细记录其年龄相关性黄斑变性(AMD)、杯盘比、糖尿病视网膜病变类似表现(糖尿病视网膜病变+视网膜零星出血)、视网膜静脉阻塞、视盘前膜及其他异常等关键结构特征。结果(1)不同年龄段下,极高海拔地区与平原地区人群AMD发生率比较,差异无统计学意义(P>0.05);(2)组内比较,在极高海拔地区人群中,20~29岁年龄段人群较其他年龄段人群杯盘比偏大发生率最高,差异有统计学意义(χ^(2)=60.502,P<0.001),组间比较,极高海拔地区30~39岁年龄段人群杯盘比偏大发生率较平原地区人群高,差异有统计学意义(χ^(2)=230.325,P<0.001);(3)组间比较,30~39岁、40~49岁年龄段糖尿病视网膜病变类似表现发生率比较,差异均有统计学意义(χ^(2)=5.390,P=0.020;χ^(2)=8.830,P=0.003);(4)组间比较,30~39岁、40~49岁年龄段静脉阻塞发生率比较,差异均无统计学意义(χ^(2)=0.071,P=0.190;χ^(2)=0.853,P=0.356),50~59岁、60岁以上年龄段静脉阻塞发生率比较,差异有统计学意义(χ^(2)=10.400,P<0.001;χ^(2)=31.848,P<0.001);(5)组间比较,30~39岁年龄段视盘前膜发生率比较,差异有统计学意义(χ^(2)=3.850,P=0.016);(6)组间比较,50~59岁、60岁以上年龄段其他黄斑部异常发生率比较,差异均有统计学意义(χ^(2)=5.080,P=0.024;χ^(2)=10.500,P=0.001)。结论极高海拔地区人群的眼底照相特征谱与平原地区存在显著差异。Objective To explore the association between fundus retinal characteristics and the prevalence of cardiovascular and cerebrovascular diseases through screening in extremely high-altitude regions(Tibet Autonomous Region).Methods A total of 2712 Tibetan residents living permanently at high altitude(4500 metres above sea level)across 51 villages in 8 townships of 3 counties(Nyima,Shuanghu,and Amdo counties)in Nagchu region of the Tibet Autonomous Region were included as the study population.Data from 1919301 health checkups conducted in lower altitude areas were used as a control group.Fundus photographs of the study population under the natural pupil conditions were coptured using the Canon Dilution-Free Fundus Camera CR-2AF from Japan,and key structural features,such as age-related macular degeneration(AMD),cup-to-disc ratio,similar manifestations of diabetic retinopathy,retinal vein occlusion,anterior optic disc,and other anomalies were recorded in detail.Results(1)No statistically significant difference in the incidence of AMD was found between extremely high-altitude areas and plain areas populations across different age groups(P>0.05);(2)Within the extremely high-altitude areas,individuals aged 20-29 had the highest incidence of enlarged cup-to-disc ratio compared to other age groups,with a statistically significant difference(χ²=60.502,P<0.001).Comparatively,the 30-39 age group in extremely high-altitude areas had a higher incidence of enlarged cup-to-disc ratio than the plain areas group,with a statistically significant difference(χ²=230.325,P<0.001);(3)The incidence rates of diabetic retinopathylike manifestations in the 30-39 and 40-49 age groups showed statistically significant differences(χ²=5.390,P=0.020;χ²=8.830,P=0.003);(4)No statistically significant differences in the incidence rates of vein occlusion were observed between the two groups in the 30-39,40-49 age groups(χ²=0.071,P=0.190;χ²=0.853,P=0.356),but a statistically significant difference was found in the 50-59 and over-60 age group

关 键 词：高原心脑血管病 眼底特征谱 西藏自治区藏族 眼底视网膜 眼底照相 

分 类 号：R743[医药卫生—神经病学与精神病学]