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中华眼科医学杂志(电子版) ›› 2020, Vol. 10 ›› Issue (03) : 166 -171. doi: 10.3877/cma.j.issn.2095-2007.2020.03.007

论著

成人睫状肌麻痹前后屈光度变化及其影响因素的流行病学研究
白大勇1, 李莉1, 魏士飞2, 李思珍3, 张烨2, 郝洁2, 王宁利4,†()   
  1. 1. 100045　首都医科大学附属北京儿童医院　儿科学国家重点学科　国家儿童医学中心
    2. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　北京市眼科学与视觉科学重点实验室
    3. 南京　211189，东南大学附属南京同仁医院眼科
    4. 100730　首都医科大学附属北京同仁医院　北京同仁眼科中心　北京市眼科研究所　北京市眼科学与视觉科学重点实验室；100191　北京大数据精准医疗高精尖创新中心（北京航空航天大学与首都医科大学眼科学院联合组建）
  • 收稿日期:2020-04-22 出版日期:2020-06-28
  • 通信作者: 王宁利
  • 基金资助:
    北京市属医学科研院所公益发展改革试点项目(京医研2016-5)

Epidemiological analysis on diopter and related factors before and after cycloplegia in adults

Dayong Bai1, Li Li1, Shifei Wei2, Sizhen Li3, Ye Zhang2, Jie Hao2, Ningli Wang4,†()   

  1. 1. National Children′s Medical Center, Pediatric National Key Discipline, Beijing Children′s Hospital, Capital Medical University, Beijing 100045, China
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China
    3. Department of Ophthalmology, Nanjing Tongren Hospital, Southeast University, Nanjing 211189, China
    4. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Institute of Ophthalmology, Beijing Key Laboratory of Ophthalmology and Visual Sciences, Beijing 100730, China; College of Ophthalmology, Capital Medical College, Beihang University, Beijing 100191, China
  • Received:2020-04-22 Published:2020-06-28
  • Corresponding author: Ningli Wang
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引用本文：

白大勇, 李莉, 魏士飞, 李思珍, 张烨, 郝洁, 王宁利. 成人睫状肌麻痹前后屈光度变化及其影响因素的流行病学研究[J]. 中华眼科医学杂志(电子版), 2020, 10(03): 166-171.

Dayong Bai, Li Li, Shifei Wei, Sizhen Li, Ye Zhang, Jie Hao, Ningli Wang. Epidemiological analysis on diopter and related factors before and after cycloplegia in adults[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2020, 10(03): 166-171.

目的

探讨成人睫状肌麻痹前后屈光度变化及其影响因素的流行病学特点。

方法

收集2012年5月至2013年6月在中国河北省邯郸永年县进行眼科屈光检查710例(1410只眼)的资料。其中，男性364例(721只眼)，女性346例(689只眼)；年龄30~83岁，平均年龄(50.9±10.3)岁。采用自动电脑验光仪检测所有受检者睫状肌麻痹前后的屈光度。采用眼科A型超声检查所有受检者睫状肌麻痹前的眼部生物学参数。所有受检者睫状肌麻痹前后等效球镜(SE)的描述采用均数±标准差表示，两者的比较采用配对t检验。不同年龄受检者睫状肌麻痹前后SE的一致性，采用Bland-Altman plots进行评估。不同性别间睫状肌麻痹后SE与睫状肌麻痹前角膜曲率K值(K)、前房深度(ACD)、眼轴长度(AL)、睫状肌麻痹后中央角膜厚度(LT)、晶状体混浊程度(NO)、晶状体核的颜色(NC)、晶状体皮质(C)及晶状体后囊下混浊的程度(PSC)的比较，采用线性混合模型分析。采用Pearson相关分析检验各屈光指标间的相关性。

结果

710例(1410只眼)受检者睫状肌麻痹前的平均SE为(-0.37±1.22)D，睫状肌麻痹后的平均SE为(0.13±1.11)D。经t检验，两者的差异有统计学意义(t＝-25.75，P<0.05)。Bland-Altman plots分析显示睫状肌麻痹后的SE发生远视漂移，且随年龄的增加该漂移逐渐减小。所有受检者睫状肌麻痹前的K值、CCT、ACD及AL，以及睫状肌麻痹后的LT、NO、NC、C及PSC分别为(44.02±1.51)D、(2.88±0.36)mm、(23.07±0.95)mm、(4.52±0.41)mm、(2.72±0.43)、(2.72±0.43)、(0.26±0.63)及(0.13±0.26)。睫状肌麻痹后的LT、NO、NC、C与SE呈正相关。经Pearson相关分析，其相关性具有统计学意义(r＝0.13，0.11，0.11，0.07；P<0.05)。受检者睫状肌麻痹前的K值、ACD、AL及睫状肌麻痹后的PSC与SE呈负相关(r＝-0.12，-0.17，-0.20，-0.13；P<0.05)。近视眼与睫状肌麻痹前的AL、睫状肌麻痹后的NO、NC、C及PSC呈负相关。经Pearson相关分析，其相关性具有统计学意义(r＝-0.22，-0.15，-0.15，-0.14，-0.42；P<0.05)。

结论

受检者睫状肌麻痹后SE发生明显的远视漂移，且随年龄增加此现象逐渐减小。睫状肌麻痹前的K、ACD、AL，以及睫状肌麻痹后的LT、NO、NC、C和PSC均与SE相关，其中影响近视眼的因素有AL、NO、NC、C及PSC。

关键词: 屈光度, 中央角膜厚度, 眼轴, 前房深度, 晶状体分级, 成人
Objective

The aim of this study was to explore the changes of diopter measurement before and after cycloplegia in adults and analysis of its related factors.

Methods

710 rural people (1410 eyes) in Yongnian County of Handan, Northern China were selected to participate in the measurement of diopter and ocular biological parameters. Among of them, there were 364 male (721 eyes) and 346 female (689 eyes). Automatic computer refractometer was used for diopter between after and before cycloplegia. Ocular biological parameters were taken by Ophthalmic A-scan before cycloplegia. Paired t-test was used for SE before and after cycloplegia. The consistency of SE before and after cycloplegia was evaluated by Bland-Altman plots among different age groups. The comparison between corneal curvature (K), len thickness (LT), anerior chamber depth (ACD), axis length (AL), nuclear opacity (NO), nuclear color (NC), cortical (C), posterior subcapsular cataract (PSC) and SE after cycloplegia in different genders was analyzed by linear mixed model. Pearson correlation analysis was used for ocular biological parameters.

Results

The mean SE of 710 cases (1410 eyes) before and after cycloplegia was respectively (-0.37±1.22) D and (0.13±1.11) D with statistical significance (t=-25.75, P<0.05). Bland-Altman analysis showed that the hyperopia drift of SE after cycloplegia decreased with the increasing of age. The characteristics of LT, NO, NC, C were positively correlated with SE after cycloplegia. After Person correlation analysis, there was significant difference among them (r=0.13, 0.11, 0.11, 0.07; P<0.05). There was a negative correlation between K, ACD, AL, PSC and SE. After Person correlation analysis, there was significant difference among them (r=-0.12, -0.17, -0.20, -0.13; P<0.05). Myopia was negatively correlated with Al, NO, NC, C and PSC. After Person correlation analysis, there was significant difference among them (r=-0.22, -0.15, -0.15, -0.14, -0.42; P<0.05).

Conclusions

The hyperopia shift of SE occurred after cycloplegia, which disappeared with the increasing of age. K, ACD, LT, AL, NO, NC, C and PSC were all related to SE after cycloplegia, among which AL, NO, NC, C and PSC were the influencing factors for myopia.

Key words: Diopter, Central corneal thickness, Ocular axis, Anterior chamber depth, Lens opacity classification system, Adult
图1 不同年龄受检者睫状肌麻痹前后等效球镜的一致性Bland-Altman plots分析图　图A~D分别示≥30岁且≤39岁、>39岁且≤49岁、>49岁且≤59岁及>59岁受检者睫状肌麻痹前后等效球镜的一致性Bland-Altman plots分析图；虚线代表95%的一致性界限
表1 不同性别受检者睫状肌麻痹前后各屈光相关参数的比较(±s)
性别 眼数(只) 等效球镜(D) 角膜曲率K值(D) 中央角膜厚度(μm) 前房深度(mm) 晶状体厚度(mm)
男 721 0.15±1.19 43.65±1.45 540.65±27.51 2.94±0.34 4.54±0.42
女 689 0.10±1.03 44.41±1.47 540.10±28.67 2.81±0.36 4.50±0.40
t值   -0.58 7.08 -0.22 -5.61 -1.65
P值   >0.05 <0.05 >0.05 <0.05 >0.05
性别 眼数(只) 眼轴长度(mm) 晶状体混浊度 晶状体颜色 皮质性白内障 后囊下性白内障
男 721 23.26±0.81 2.78±0.45 2.78±0.45 0.23±0.54 0.14±0.29
女 689 22.87±1.04 2.66±0.39 2.66±0.39 0.29±0.72 0.12±0.22
t值   -6.69 -3.87 -3.87 1.31 -0.99
P值   <0.05 <0.05 <0.05 >0.05 >0.05
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