云南少数民族地区青光眼五年发病率随访及盲和视力损伤的流行病学调查

发布时间：2018-05-30 06:48

本文选题：开角型青光眼 + 发病率　；参考：《昆明医科大学》2016年博士论文

【摘要】：青光眼是全球第二大致盲眼病,是不可逆性盲最主要的原因,原发性开角型青光眼(primary open-angle glaucoma,POAG)是最常见的青光眼类型。POAG因其发病隐匿,早期诊断困难,即使在发达国家该病的漏诊率也高达50%,多数患者初次就诊时已经伴有明显的青光眼视神经损害,因此对社会、经济影响较大,已成为一个重要的社会公共卫生问题。中国是世界上青光眼患病人数最多的国家,随着诊断水平的不断提高,我国POAG在青光眼中的构成比正逐渐增高。中国是一个人口大国,而农村人口占大多数,同时地域辽阔,少数民族聚居,因此对农村少数民族进行POAG的流行病学调查也具有非常重要的意义。我国目前对青光眼的流行病学调查多集中于横断面的患病率报道,而对于发病率的研究报道尚为空白,这是因为进行发病率的研究常需投入较大的人力、物力及财力；另一方面POAG的发病特点是发病隐匿,病程长,诊断困难,且发病率较低,因此确定其发病率较为困难。盲和视力损伤是全球性严重的社会和经济问题,不但严重影响了人民群众的身体健康和生活质量,也给家庭和社会带来了沉重的负担。2010年,wHO发表了全球视力损伤的最新估计,全球约有中重度视力损伤2.46亿人,其中盲人约占3900万。中国是世界上盲和视力损伤最严重的国家之一,准确的盲和视力损伤数据,有助于国际卫生组织和国内卫生机构在制定防盲治盲的卫生策略时可有效、合理的分配有限的卫生资源。云南省位于我国西南部,是我国社会经济发展较落后的边疆省份之一,也是我国拥有少数民族最多的省份,目前,关于云南少数民族眼病的流行病学资料还是一个空白。本研究为云南省少数民族眼病研究的一部分,通过对白族和傣族50岁以上农村人群POAG和视力损伤的发病情况进行调查,了解云南省少数民族地区可致盲眼病的发生和防治情况。我们的调查结果为今后在云南省及西部边远农村和中国其他少数民族地区防盲治盲策略的制定、眼病的早期干预和公共卫生政策的制定提供科学依据,同时也有助于针对性地开展农村地区可致盲眼病的疾病防治和健康促进工作。第一部分50岁以上农村白族原发开角型青光眼5年发病率随访研究[目的]探讨中国农村50岁以上白族原发性开角型青光眼(primary open-angle glaucoma,POAG)的5年累积发病率及其相关危险因素,为农村地区原发性开角型青光眼的预防控制提供循证依据；[方法]通过以人群为基础的队列研究,对2010年曾参与过青光眼筛查的大理农村地区50岁以上的白族再次进行5年后的随访检查,参与者中曾在2010年被查出任何一只眼患有原发性青光眼者排外,检查项目包括：视力、眼压、前房角、视乳头、杯盘比及视野、眼底照相等,同时进行身高、体重及血糖、血压测量,问卷调查全身疾病、受教育程度、吸烟、饮酒情况及青光眼家族史等。青光眼诊断标准采用国际地域及流行病学组的诊断标准,经大理地区人口统计学校正后计算POAG的5年累积发病率,并采用多变量回归模型计算POAG各相关危险因素的比值比(OR)和95%置信区间(CI);[结果]1520名曾参与过基线研究的人群接受了5年期的随访检查,随访率达80.6%；其中原青光眼患者35例排外,新发POAG患者19例,5年累积发病率为1.3%(95%CI,0.7-1.9)；POAG的发病率随年龄的增长呈正相关且具有统计学意义(P0.05),发病率50-59岁为0.4%(95% CI,0.3 to 0.4),60-69岁为0.6%(95% CI,0.5 to 0.7),70岁以上为2.1%(95% CI,1.9-2.3);性别与POAG的发病无显著相关性,其他相关的危险因素包括：眼压(OR,3.5,95% CI2.0 to 5.9,每10mmHg增加)、垂直杯盘比(OR 9.7,95% CI 2.1 to 45.5,VCDR0.7)及近视(OR 3.6,95% CI 1.4 to 8.9,等效球镜-0.5D);受教育为保护因素。[结论]云南省大理农村地区白族50岁以上人群POAG的发病率低于非洲裔及大多数白种人；POAG的发病率随年龄的增长显著增加,同时随眼压,VCDR,近视度数的增加发病率有增加趋势；我国西部边远农村地区POAG的早期诊断和治疗率较低,应引起政府及相关卫生部门的重视。本项研究结果对我国公共卫生部门制定POAG筛查策略,合理分配医疗资源等方面具有非常重要的指导意义。第二部分傣族和彝族50岁以上农村人群盲和视力损伤的流行病学调查[目的]调查云南省傣族和彝族50岁以上农村人群盲和视力损伤的患病率、主要病因构成及其相关危险因素,了解盲和视力损伤的现状及几种主要致盲眼病的致盲情况,确定云南省农村少数民族防盲治盲工作的重点防治对象和重点防治疾病,为云南省农村地区防盲治盲工作的开展提供依据。[方法]采用以人群为基础的横断面调查对西双版纳和石林县农村50岁以上的傣族和彝族人群进行可致盲眼病的筛查。检查内容包括视力检查、验光、眼前段检查、眼底检查,必要时测量眼压。视力检查使用糖尿病视网膜病变早期治疗研究视力表,进行日常生活视力(presenting visual acuity,PVA)和最佳矫正视力(best-corrected visual acuity, BCVA)检查。根据检查结果对所有PVA0.3的眼做出引起盲和视力损伤的主要眼病的诊断。分别以PVA和BCVA为标准,计算引起盲和视力损伤的眼病构成比。[结果]一、傣族眼病调查结果1.共2163名傣族接受了检查,排除其中不能完成视力检查的13人,最终2150名傣族纳入本次调查统计分析,受检率为80.5%。各个年龄段的受检率不一致,随着年龄的增加受检率增加;女性的受检率明显高于男性;受教育水平对受检率影响不明显。2.按BCVA计算,盲46例,患病率为2.14%,视力损伤145例,患病率为6.74%;按PVA计算,盲64例,患病率为2.98%,视力损伤287例,患病率为13.35%.校正性别和受教育程度后,BCVA和PVA所得盲的相对危险度均随着年龄增加而增加;校正年龄和受教育程度后,男性盲的患病率高于女性。低水平的受教育程度相对高水平受教育程度发生视力损伤的危险性增加,但差异无统计学意义。3.按人数计算,以BCVA为标准,傣族引起盲的前三位主要眼病依次为白内障(73.91%),青光眼(8.7%)和高度近视黄斑病变(6.52%)；引起视力损伤的前三位主要眼病依次为白内障(66.90%)、年龄相关性黄斑病变(Age-related Macular Degeneration,AMD)(11.03%)和高度近视黄斑病变(7.59%)。以PVA为标准,引起盲的前三位主要眼病依次为白内障(68.25%)、高度近视黄斑病变(9.52%)和青光眼(6.35%);引起视力损伤的前三位主要眼病依次为白内障(62.98%)、屈光不正(11.76%)和年龄相关性黄斑病变(6.57%)。二、彝族眼病调查结果1.共2214名彝族接受了检查,排除其中不能完成视力检查的6人,最终2208名彝族纳入本次调查统计分析,受检率为81.0%。各个年龄段的受检率不一致,随着年龄的增加受检率增加;女性的受检率明显高于男性;受教育水平对受检率影响不明显。2.按BCVA计算,盲38例,患病率为1.7%,视力损伤180例,患病率为8.2%;按PVA计算,盲46例,患病率为2.1%,视力损伤422例,患病率为19.1%.校正性别和受教育程度后,BCVA和PVA所得盲的相对危险度均随着年龄增加而增加。低水平的受教育程度相对高水平受教育程度发生视力损伤和盲的危险性增加。3.按人数计算,以BCVA为标准,彝族引起盲的前三位主要眼病依次为白内障(71.1%),年龄相关性黄斑病变(10.5%)和角膜混浊(5.3%)；引起视力损伤的前三位主要眼病依次为白内障(66.7%)、高度近视黄斑病变(7.8%)和年龄相关性黄斑病变(6.7%)。以PVA为标准,引起盲的前三位主要眼病依次为白内障(63.0%)、年龄相关性黄斑病变(10.9)和高度近视黄斑病变(6.5%);引起视力损伤的前三位主要眼病依次为白内障(69.4%)、屈光不正(7.6%)和年龄相关性黄斑病变(4.5%)。[结论]傣族和彝族50岁以上农村人群盲和视力损伤的患病率高于国内多数汉族地区的眼病调查结果。致盲和视力损伤的主要原因为白内障,使用PVA时,屈光不正是视力损伤的第二位原因；矫正屈光不正后,年龄相关性黄斑病变为视力损伤的第二位原因。少数民族地区农村人群盲和视力损伤的原因中大多是可避免或者可预防的,防盲治盲的重点应放在自内障的治疗上,同时应关注屈光不正的矫正。傣族和彝族盲的患病率均随年龄增加而增加。本调查结果对我国边疆少数民族地区开展防盲治盲工作具有重要的指导意义。
[Abstract]:Glaucoma is the second general blindness disease in the world. It is the most important cause of irreversible blindness. Primary open-angle glaucoma (POAG) is the most common type of glaucoma, which is the most common type of glaucoma due to its concealment. Early diagnosis is difficult. Even in developed countries, the rate of missed diagnosis is up to 50%. Most patients have been accompanied by the first visit. There are obvious glaucomatous optic nerve damage, so it has great influence on society and economy and has become an important social public health problem. China is the country with the largest number of glaucoma in the world. With the continuous improvement of the level of diagnosis, the composition ratio of POAG in glaucoma is increasing gradually. China is a large population, and agriculture is a big country. The population of the village is large, the region is vast and the minority nationalities live together. Therefore, it is also of great significance to carry out the epidemiological investigation of the POAG in the rural minority. The epidemiological investigation of glaucoma is mostly concentrated on the prevalence rate of the cross section, but the Research Report on the incidence of the disease is still blank, because it is carried out. On the other hand, the incidence of POAG is characterized by insidious disease, long disease course, difficult diagnosis and low incidence, so it is difficult to determine the incidence of the disease. Blindness and visual impairment are serious social and economic problems in the world, which not only seriously affect the health of the people. The quality of life and the quality of life have brought a heavy burden to families and Society for.2010 years. WHO published the latest estimates of global visual impairment. There are about 246 million people in the world with moderate to severe visual impairment, of which 39 million are blind. China is one of the world's most blind and visually impaired countries. Accurate blindness and visual impairment data are helpful to international health. Yunnan province is located in the southwest of China, is one of the frontier provinces of backward social and economic development in China, is also one of the provinces with the largest minority nationality in our country. At present, the epidemic of ethnic minority eye diseases in Yunnan is popular. The study is still a blank. This study is part of the study of minority eye diseases in Yunnan province. Through the investigation of the incidence of POAG and visual impairment in the Bai and Dai people over 50 years old, we know the occurrence and prevention of blind eye diseases in the minority areas of Yunnan province. The results of our investigation are in Yunnan Province in the future. It also provides scientific basis for the early intervention of ophthalmopathy and the formulation of public health policies, and also helps to carry out the disease prevention and health promotion of blind eye diseases in rural areas. The first part of the primary open angle of the rural Bai people over 50 years old. Follow up study on the incidence of 5 year glaucoma (Objective] to explore the 5 year cumulative incidence of primary open-angle glaucoma (POAG) and related risk factors for primary open angle glaucoma (open-angle glaucoma, POAG) in rural areas of China, and to provide evidence-based evidence for prevention and control of primary open angle glaucoma in rural areas. A cohort study of the Bai people over 50 years old and over in rural Dali, which had participated in glaucoma screening in 2010, was followed up for 5 years. In 2010, the participants were found out of any one eye with primary glaucoma. The examination included vision, IOP, anterior chamber angle, papilla, cup and disc ratio, visual field, and fundus photography At the same time, height, weight and blood sugar, blood pressure measurement, questionnaire survey of systemic disease, education, smoking, drinking and family history of glaucoma. The criteria for the diagnosis of glaucoma in the international and epidemiological group were used. The 5 year cumulative incidence of POAG was calculated after the population statistics school in Dali. A quantitative regression model was used to calculate the ratio Ratio (OR) and 95% confidence interval (CI) of POAG related risk factors; [results] the population of]1520 who had been involved in the baseline study received a follow-up of 5 years, with a follow-up rate of 80.6%, of which 35 cases of primary glaucoma, 19 new POAG patients, 1.3% (95%CI, 0.7-1.9), 5 years of cumulative incidence, and POAG's hair. The incidence of disease was positively correlated with age (P0.05), the incidence was 0.4% (95% CI, 0.3 to 0.4), 60-69 years old 0.6% (95% CI, 0.5 to 0.7) and 2.1% (95% CI, 1.9-2.3), and no significant correlation between sex and POAG, and other related risk factors included: Intraocular pressure (OR, 3.5,95% CI2.0 to 5.9, each individual) Increase), the vertical cup and disk ratio (OR 9.7,95% CI 2.1 to 45.5, VCDR0.7) and myopia (OR 3.6,95% CI 1.4 to 8.9, equivalent ball mirror -0.5D); education as a protective factor. [Conclusion] the incidence of POAG in the Bai people over 50 years old in the rural areas of Dali of Yunnan Province is lower than that of African descent and most of the white people; the incidence of POAG is significantly increased with age. At the same time, the incidence of intraocular pressure, VCDR and myopia increased, and the early diagnosis and treatment rate of POAG in the remote rural areas of China were low, which should arouse the attention of the government and the relevant health departments. The results of this study are very important to the public health department of our country to formulate the strategy of POAG screening and to allocate medical resources reasonably. The second part of the epidemiological survey on the blindness and visual impairment of the Dai and Yi people over 50 years of age in rural areas (Objective] to investigate the prevalence of blindness and visual impairment in the Dai and Yi people over 50 years old in Yunnan Province, the main causes and related risk factors, and to understand the status of blindness and visual impairment and several major blindness. The problem of blindness in the rural areas of Yunnan Province, the key prevention and control of blindness prevention and prevention of blindness in rural areas of the rural areas of Yunnan Province, and the prevention and treatment of diseases, provide the basis for the blind prevention and cure of blindness in rural areas of Yunnan province. Screening for blinding ophthalmopathy. Examination contents include visual examination, optometry, anterior segment examination, fundus examination, and measurement of intraocular pressure when necessary. Visual acuity examination uses the early treatment of diabetic retinopathy to study the visual acuity (presenting visual acuity, PVA) and the best corrected visual acuity (best-corrected visual acuity, BCV). A) examination. According to the results of the examination, all PVA0.3 eyes were diagnosed with blindness and visual impairment. According to the criteria of PVA and BCVA, the ratio of blindness and visual impairment was calculated. [results] 1, 2163 Dai people were examined in 1. Dai People's ophthalmopathy investigation results, excluding 13 of them who were unable to complete the visual examination. The final 2150 Dai people were included in the statistical analysis of this survey. The test rates of each age group of 80.5%. were not consistent, with the increase of the age, the rate of women was significantly higher than that of the male; the effect of the education level on the rate of examination was not obvious.2. according to BCVA, the blindness was 2.14%, the incidence of visual impairment was 145, and the prevalence rate was 6.74%. According to PVA, 64 cases of blindness, the prevalence of 2.98%, 287 cases of visual impairment, and the prevalence of 13.35%. corrected sex and education, the relative risk of BCVA and PVA increased with age; the prevalence rate of male blindness was higher than that of women after the correction of age and education. The lower level of education was higher education. The risk of visual impairment increased, but the difference was not statistically significant.3. according to the number of people, with BCVA as the standard, the first three major ocular diseases causing blindness in Dai nationality were cataract (73.91%), glaucoma (8.7%) and high myopia macular lesion (6.52%), and the first three major ocular diseases causing visual impairment were cataract (66.90%), age Associated macular lesions (Age-related Macular Degeneration, AMD) (11.03%) and high myopia macular lesions (7.59%). The first three major ophthalmopathy that caused blindness were cataract (68.25%), high myopia macular lesions (9.52%) and glaucoma (6.35%), and the first three major ocular diseases causing visual impairment were cataract (62.98%). Ametropia (11.76%) and age related macular disease (6.57%). Two, Yi People's eye disease survey results 1., 2214 Yi people were examined, excluding 6 people who could not complete vision examination, and 2208 Yi people were included in this investigation and analysis. The test rate of each age of 81.0%. was not consistent, with the increase of age. The rate of female examination was significantly higher than that of men; the education level was not significantly affected by.2., 38 blinded, 1.7%, 180, 8.2%, 46, 2.1%, 422 of visual impairment by PVA, and after the 19.1%. correction of sex and education, BCVA and PVA were blinded. The relative risk degree increased with age. The lower level of education was relatively high and the risk of visual impairment and blindness increased by.3. according to the number of people. The first three major ophthalmopathy caused by the Yi people were cataract (71.1%), age related macular lesions (10.5%) and corneal opacities (5.3). The first three major ocular diseases causing visual impairment were cataract (66.7%), high myopia macular lesion (7.8%) and age-related macular disease (6.7%). The first three major ophthalmopathy were cataract (63%), age related macular lesions (10.9) and high myopia macular lesions (6.5%), and visual impairment. The first three major ocular diseases were cataract (69.4%), ametropia (7.6%) and age-related macular lesions (4.5%). [Conclusion] the incidence of blindness and visual impairment in the Dai and Yi people over 50 years old is higher than that in most of the Han nationality areas. The main cause of blindness and visual impairment is cataract, when PVA is used, Ametropia is the second cause of visual impairment; after correction of ametropia, age related macular lesions are the second causes of visual impairment. Most of the causes of blindness and visual impairment in rural population in ethnic minority areas are avoidable or preventable. The focus of blindness prevention should be on the treatment of cataract and at the same time should pay attention to flexion. The prevalence of blindness between the Dai and Yi people is increased with age. The results of this survey have important guiding significance for the prevention of blindness in the minority areas in the border areas of China.
【学位授予单位】：昆明医科大学
【学位级别】：博士
【学位授予年份】：2016
【分类号】：R775

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