山东省农村50岁及以上人群盲与视力损伤、白内障患病率及白内障手术状况的调查研究

发布时间：2018-05-07 19:02

本文选题：白内障 + 患病率　；参考：《山东大学》2014年博士论文

【摘要】：[研究背景]在我国乃至全世界范围内,盲与重度视力损伤仍然是公认的公共卫生问题,而最主要的致盲眼病依然是白内障。山东省曾于1986年进行过一次以最佳矫正视力为标准的盲和低视力的眼病流行病学调查,当时的调查结果未涉及到白内障的手术状况。近20年来,山东省的人口老龄化程度及人口构成比发生了很大变化,同时社会经济水平和医疗卫生保障体系也有了较大的发展。世界卫生组织在2003年提出了“日常生活视力”的概念,并重新以日常生活视力定义了盲和视力损伤。因此,为了解山东省农村50岁及以上人群盲与中、重度视力损伤情况、导致盲与中、重度视力损伤的病因以及白内障患病情况和白内障手术治疗状况及效果,我们于2008年4月至7月进行了山东省农村50岁及以上人群盲与视力损伤患病状况的流行病学抽样调查研究。 [目的]调查山东省农村50岁及以上人群盲与中、重度视力损伤的患病率、盲与中、重度视力损伤的主要病因、白内障患病率、白内障手术覆盖率和白内障盲人社会负担率。 [方法]以人群为基础的横断面调查研究,采用整群随机抽样研究方法。2008年4-7月在山东省3个不同经济发展水平的县(市)中各选择1个县(市)作为调查地[乳山市(经济发达)、滕州市(经济中等发达)、鄄城县(经济较贫困)],另外选择1个人均国内生产总值中等城市市区的郊区农村作为调查地(济南市槐荫区)。所有受检者首先接受盲与中、重度视力损伤问卷调查,然后由验光师对所有受检者进行裸眼视力和日常生活视力检查,对于一只眼日常生活视力≤0.5的受检者继续电脑验光和最佳矫正视力检查,最后由眼科医师对受检者进行全面的眼部检查,包括应用裂隙灯显微镜检查眼前节并评价晶状体混浊程度和白内障手术状况,应用直接检眼镜检查玻璃体及眼底。眼科检查医师对日常生活视力低于0.3的眼做出引起盲与中、重度视力损伤的病因诊断。盲与中、重度视力损伤及白内障的患病率统计提供95%可信区间,不同组之间患病率的比较应用卡方检验；盲与中、重度视力损伤患病率的影响因素、白内障的相关危险因素及白内障手术覆盖率、白内障盲人社会负担率的影响因素应用多元Logistic回归分析；不同年龄、性别、文化程度、调查地点白内障患者手术眼术后日常生活视力和最佳矫正视力分布情况应用描述性统计分析。 [结果]在全部调查地点,共检录50岁及以上人数19583人,实际受检17816人,受检率为90.98%。(1)以日常生活视力统计,盲的患病率为1.58%(95%CI1.39%-1.76%),中重度视力损伤的患病率为7.01%(95%CI6.63%-7.39%)；以最佳矫正视力统计,盲的患病率为1.33%(95%CI1.16%-1.50%),中重度视力损伤的患病率为3.66%(95%CI3.38%-3.94%)；(2)以日常生活视力统计,导致中、重度视力损伤的前三位的主要眼病依次为白内障(54.1%),未矫正的屈光不正(21.3%)和眼底病(11.9%)；导致盲的主要疾病依次为白内障(59.8%),眼底病(12.1%),角膜瘢痕或混浊(4.3%)及未矫正的屈光不正(4.3%)。以最佳矫正视力统计,导致中、重度视力损伤的前三位的主要眼病依次为白内障(67.0%),眼底病(17.9%)和弱视(3.7%)；导致盲的主要病因依次为白内障(64.6%),眼底病(10.6%)和角膜瘢痕或混浊(4.6%)。关于白内障盲的患病率,分别以日常生活视力和最佳矫正视力为标准,为0.94%(95%CI0.80%-1.08%)和0.86%(95%CI0.72%-1.00%)；(3)在17816名受检者中,发现白内障4938人,患病率为27.72%。高龄、女性、文盲人群的白内障患病率增高(P0.01)。在受检的4938名白内障患者中,249人310只眼接受了白内障手术,接受白内障手术的比率为1.40%；其中194眼(62.58%)采用现代囊外摘除联合人工晶状体(I0L)植入术,32眼(10.32%)采用超声乳化吸除联合IOL植入术；239眼植入了IOL,IOL植入率为77.10%。白内障手术覆盖率为36.77%,白内障盲人社会负担率为2.12%。随着年龄增长和文化程度降低,白内障盲人社会负担率逐渐增高,这种变化趋势有统计学意义(P0.05)。 [结论]盲与中、重度视力损伤依然是山东省的重要公共卫生问题。白内障仍然是山东省农村50岁及以上人群盲与中、重度视力损伤的首要原因。目前我省农村的白内障患病率较高、白内障手术覆盖率仍较低,手术治疗白内障盲依然是我省防盲工作的重点。
[Abstract]:The epidemiological investigation of blindness and severe visual impairment is still a recognized public health problem in China and even the whole world . In recent 20 years , there has been a great change in blindness and blindness in Shandong province . In recent 20 years , the population aging degree and population composition ratio in Shandong province have changed greatly .

Objective : To investigate the prevalence of blindness and moderate and severe visual impairment among people aged 50 and above in rural areas of Shandong Province .

In April to July 2008 , 1 county ( city ) was selected as the investigation ground ( city of Jinan City ) .
Multivariate logistic regression analysis was applied to the influencing factors of the prevalence of blindness and moderate and severe visual impairment , the related risk factors of cataract , the coverage of cataract surgery and the social burden of cataract .
Descriptive statistics were used to investigate the postoperative visual acuity and the best corrected visual acuity in patients with cataract at different ages , sex , and culture .

Results The prevalence rate of blindness was 1 . 58 % ( 95 % CI1 . 39 % - 1 . 76 % ) , and the prevalence of severe visual impairment was 7.01 % ( 95 % CI 6.63 % - 7.39 % ) .
The prevalence of blindness was 1.33 % ( 95 % CI 1.16 % - 1.50 % ) and 3.66 % ( 95 % CI 3.38 % - 3.94 % ) .
( 2 ) The main ocular diseases were cataract ( 54.1 % ) , uncorrected refractive error ( 21.3 % ) and fundus disease ( 11.9 % ) .
The main diseases caused blindness were cataract ( 59.8 % ) , ocular fundus disease ( 12.1 % ) , corneal scar or opacity ( 4.3 % ) and uncorrected refractive error ( 4.3 % ) . The main ocular diseases were cataract ( 67.0 % ) , fundus disease ( 17.9 % ) and amblyopia ( 3.7 % ) .
The main cause of blindness was cataract ( 64.6 % ) , fundus disease ( 10.6 % ) and corneal scar or opacity ( 4.6 % ) . The prevalence of cataract blindness was 0.94 % ( 95 % CI 0.80 % - 1.08 % ) and 0.86 % ( 95 % CI 0.72 % - 1.00 % ) , respectively .
( 3 ) Of the 17,816 subjects , 4938 cataract was found , the prevalence rate was 27.72 % . Among the 4938 cataract patients , 249 patients received cataract surgery and the ratio of cataract surgery was 1.40 % .
Among them , 194 eyes ( 62.58 % ) were implanted with IOL ( I0L ) and 32 eyes ( 10.32 % ) by phacoemulsification and IOL implantation .
IOL implantation rate was 77.10 % . The coverage rate of cataract was 36.77 % , and the social burden rate of cataract was 2.12 % .

Conclusion The blindness and middle and severe visual impairment are still important public health problems in Shandong province . The cataract is still the primary cause of blindness and middle and severe visual impairment among the population aged 50 and above in Shandong province .

【学位授予单位】：山东大学
【学位级别】：博士
【学位授予年份】：2014
【分类号】：R779.6

【参考文献】