玻璃体黄斑界面疾病临床资料及危险因素分析

发布时间：2018-03-30 20:11

本文选题：玻璃体黄斑界面疾病　切入点：住院患者　出处：《上海交通大学》2015年博士论文

【摘要】：背景:玻璃体黄斑界面(vitreomacular interface,VMI)疾病是一类由于VMI病理改变而引起的年龄相关性退行性病变,主要包括黄斑前膜(epiretinal membrane,ERM)、黄斑裂孔(macular hole,MH)、玻璃体黄斑牵引综合征(vitreomacular traction syndrome,VTS)、黄斑劈裂等。本课题组前期研究发现,VMI疾病已成为本院眼科手术量的第三位,是威胁老年人视觉质量的重要因素。控制VMI疾病的关键在于预防,而预防的关键在于明确其发病规律及其危险因素。然而,目前国内外尚缺乏这方面的研究报告。目的:分析近5年来本院眼科收治VMI疾病患者临床资料,初步筛选出与VMI疾病发生相关的危险因素。方法:(1)回顾性收集2010年1月至2014年12月本院眼科收治的VMI疾病患者临床资料,包括性别、年龄、主要诊断、其他诊断等,对以上资料进行统计分析,深入挖掘VMI疾病总体及各类病种患者特征;(2)回顾性收集2014年1月至2014年12月本院眼科收治入院的VMI疾病患者临床资料,并收集健康体检中心接受健康体检者临床资料作为对照组。对所有入选研究对象进行详细的眼科检查和病史收集,收集的病史资料包括:学历,抽烟、饮酒习惯,屈光状态,糖尿病、高血压及高脂血症等全身疾病史。并取血清进行性激素六项检测,包括:卵泡刺激素(FSH)、黄体生成激素(LH)、雌二醇(E2)、孕酮(P)、睾酮(T)及催乳素(PRL);(3)对以上计数资料采用卡方检验;对正态分布的计量资料采用独立样本t检验;对非正态分布的计量资料采用非参数检验进行组间比较,筛选出有统计学意义的变量,进行多因素非条件Logistic回归分析。结果:(1)近5年来,本院眼科收治入院的VMI疾病患者共979例,男性患者共287例,女性患者共692例,男女比例为1:2.4。近5年VMI疾病患者平均年龄61.6岁,其中男性患者62.3岁,女性患者61.4岁。男女性患者年龄分布情况不同:男性患者的发病率增高趋势较为缓和,总体呈现随年龄增长,发病率增高;而女性患者呈现绝经后发病率陡增的特点,集中分布于56~65岁年龄段。近5年主要诊断为特发性ERM、特发性MH及VTS的患者分别为454例、502例及24例,各病种历年患者量均呈现上升趋势;男女比例分别为1:2.3、1:2.4、1:3.8,男女性VMI疾病患者病谱构成情况类似。合并高血压、II型糖尿病的VMI疾病患者分别占11.5%、3.5%;(2)危险因素分析共纳入VMI疾病患者73例,男性患者20例,女性患者53例,平均年龄为63.4岁;男性患者中,IERM、IMH、VTS分别为9例、11例、1例;女性患者中,IERM、IMH、VTS分别为27例、23例、3例。单因素分析结果显示:男性VMI疾病患者以上各项研究因素与对照组差异均不显著;女性VMI疾病患者血清雌二醇(estrodiol,E2)、孕酮(progesterone,P)、催乳素(prolactin,PRL)及睾酮(testosterone,T)水平均显著低于对照组;对不同病种女性VMI疾病患者进一步进行分析,女性IERM及IMH患者分别在血清E2、T及E2、P、T水平上显著低于对照组。结论:近5年来,本院眼科VMI疾病收治量逐年稳步递增。绝经后早期女性最为高发,男性患者发病晚于女性,且发病率随年龄增高而上升。女性VMI疾病患者多项性激素水平显著低于对照组,E2与T尤为明显;未发现男性VMI疾病显著危险因素,提示男女性VMI疾病发病机制可能存在差异。
[Abstract]:Background: vitreous body interface (vitreomacular interface, VMI macular disease) is a kind of age-related degenerative lesions due to pathological changes caused by VMI, including macular epiretinal membrane (epiretinal, membrane, ERM), macular hole (macular hole, MH), vitreous body macular traction syndrome (vitreomacular traction, syndrome, VTS). Macular retinoschisis. Previous studies showed that VMI disease has become the hospital surgical volume of third, is an important factor threatening the visual quality of the elderly. The key control of VMI disease is prevention, and prevention is the key to clear the pathogenesis and risk factors. However, there is still lack of research report both at home and abroad. Objective: to analyze the past 5 years in our hospital were VMI disease patients with clinical data, preliminary screening risk factors associated with VMI disease. Methods: (1) were collected from January 2010 to The clinical data of patients with VMI disease from December 2014 in our hospital including gender, age, primary diagnosis, diagnosis, and statistical analysis of the above information, dig the overall VMI disease and all kinds of disease characteristics; (2) clinical data of patients with VMI disease were retrospectively collected from January 2014 to December 2014, the hospital admitted to hospital, and collect the health examination center received physical examination as the control group. The clinical data of detailed ophthalmologic examination and history collection of all subjects, history data collection including: education, smoking, drinking habits, refractive status, diabetes, hypertension and hyperlipidemia history of systemic diseases. And serum sex hormone six testing, including: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone (P), testosterone (T) and prolactin (PRL); (3) the count data by chi square test ; independent samples t test was used for measurement data of normal distribution; the non normal distribution of the measurement data using non parametric test for comparison between groups, were statistically significant variables, multivariate non conditional Logistic regression analysis. Results: (1) in the past 5 years, the hospital admitted to hospital VMI disease patients with a total of 979 cases of male patients with a total of 287 cases of female patients in 692 cases, the ratio of male to female was nearly 5 years of 1:2.4. VMI disease patients with an average age of 61.6 years, of which 62.3 were male, female patients 61.4 years of age. Men and women of different age distribution of patients: the incidence of male patients were significantly increased in the trend of more moderate, generally with the increase of age, the increased incidence of female patients; and has the characteristics of incidence sharply after menopause, concentrated in the 56~65 years of age. The last 5 years for the diagnosis of idiopathic ERM, idiopathic MH and VTS patients were 454 cases, 502 cases and 24 Cases of various diseases over the years were increased; the proportion of men and women were 1:2.3,1:2.4,1:3.8, a similar spectrum of male and female VMI patients. Patients with hypertension, type II diabetes patients with VMI disease accounted for 11.5%, 3.5%; (2) risk factors included 73 patients with VMI disease, 20 cases of male patients. 53 cases of female patients, the average age is 63.4 years old; male patients, IERM, IMH, VTS were 9 cases, 11 cases, 1 cases; female patients, IERM, IMH, VTS were 27 cases, 23 cases, 3 cases. Univariate analysis showed that the factors of male VMI difference with control group. The studies above patients were not significant; female serum estradiol in patients with VMI disease (estrodiol, E2), progesterone (progesterone, P), prolactin (prolactin, PRL) and testosterone (testosterone, T) was significantly lower than the control group; the patients with different diseases of female VMI disease further analysis, female IERM And IMH patients respectively in serum E2, T and E2, P, T level was significantly lower than the control group. Conclusion: in the past 5 years, our hospital ophthalmology VMI disease steadily increasing. The high incidence of early postmenopausal women, the incidence of male patients than female, and the incidence rate increased with age and increased number. The sex hormone levels in female patients with VMI disease were significantly lower than the control group, E2 and T is obvious; no significant risk factors found in male VMI disease, suggesting that the male and female VMI disease mechanisms are different.

【学位授予单位】：上海交通大学
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R774.5

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