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中华眼科医学杂志(电子版)

中华眼科医学杂志(电子版) ›› 2022, Vol. 12 ›› Issue (05) : 281 -286. doi: 10.3877/cma.j.issn.2095-2007.2022.05.005

论著

60岁以上社区人群特发性黄斑前膜全身性危险因素的流行病学研究
肖玥言1, 魏文斌2,†(), 郗平1, 高博1, 王嘉南1, 耿云云1, 郑敏1, 焦凤影3   
  1. 1. 101318　北京市顺义区空港医院眼科
    2. 100730　北京首都医科大学附属北京同仁医院眼科中心
    3. 101300　北京市顺义区天竺镇卫生院全科医学科
  • 收稿日期:2022-06-01 出版日期:2022-10-28
  • 通信作者: 魏文斌
  • 基金资助:
    首都卫生发展科研专项项目(首发2020－1－2052); 北京市科委科技计划项目(Z201100005520045，Z181100001818003); 北京市医院管理局"登峰"人才培养计划项目(DFL20150201)

Epidemiological analysis on the systemic risk factors for the idiopathic macular membrane in the community residents over 60 years old

Yueyan Xiao1, Wenbin Wei2,†(), Ping Xi1, Bo Gao1, Jianan Wang1, Yunyun Geng1, Min Zheng1, Fengying Jiao3   

  1. 1. Department of Ophthalmology, Beijng Shunyi Airport Hospital, Beijing 101318, China
    2. Beijing Tongren Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
    3. Department of General Clinic, Tianzhu Town Hospital of Shunyi District, Beijing 101300, China
  • Received:2022-06-01 Published:2022-10-28
  • Corresponding author: Wenbin Wei
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引用本文：

肖玥言, 魏文斌, 郗平, 高博, 王嘉南, 耿云云, 郑敏, 焦凤影. 60岁以上社区人群特发性黄斑前膜全身性危险因素的流行病学研究[J]. 中华眼科医学杂志(电子版), 2022, 12(05): 281-286.

Yueyan Xiao, Wenbin Wei, Ping Xi, Bo Gao, Jianan Wang, Yunyun Geng, Min Zheng, Fengying Jiao. Epidemiological analysis on the systemic risk factors for the idiopathic macular membrane in the community residents over 60 years old[J]. Chinese Journal of Ophthalmologic Medicine(Electronic Edition), 2022, 12(05): 281-286.

目的

探讨60岁以上社区人群发生特发性黄斑前膜(IMEM)的全身性相关危险因素。

方法

收集2017年3月至2017年11月北京市顺义区天竺镇60岁以上常住居民2853例(5686只眼)的体检数据资料进行研究。其中，男性1309例(2600只眼)，女性1544例(3086只眼)；年龄60~83岁，平均年龄(65.3±4.6)岁。现场调查内容包括基本信息调查问卷、一般体格检查、眼部常规检查及彩色眼底照相。将符合IMEM纳入标准者定义为IMEM组；在其他无黄斑前膜人群中匹配性别和年龄，采用数字表法随机抽取1：1比例人群定义为对照组。本研究采集的年龄、腰围、身体质量指数、血压及血生化指标，采用(±s)表示，两组的比较采用独立样本t检验。性别、生活习惯、饮食习惯及高血压病史等全身慢性疾病病史，采用例数和百分比描述，组间比较采用卡方检验。IMEM相关的全身因素，采用Logistic回归进行分析。

结果

全部2853例(5686只眼)居民中，患有IMEM者177例(212只眼)。其中，男性62例(70只眼)，女性115例(142只眼)，年龄60~81岁，平均年龄(67.5±5.2)岁。两组基本情况比较中，腰围、收缩压、低密度脂蛋白及空腹血糖的差异具有统计学意义(t＝－2.73，2.26，－3.21，2.13；P<0.05)。高血压病史及糖尿病病史的差异具有统计学意义(χ2 ＝4.52，4.98；P<0.05)。经单因素Logistic回归分析，高血压病史、糖尿病病史、腰围、收缩压、低密度脂蛋白及空腹血糖等全身因素与IMEM的相关性具有统计学意义(OR＝0.60，0.62，1.03，0.99，1.81，0.91；95%CI：0.38~0.96，0.41~0.94，1.01~1.04，0.98~0.998，1.25~2.63，0.84~0.994；P<0.05)。去除具有共线性的指标和混杂因素后，再经多因素Logistic回归分析，其中腰围和低密度脂蛋白两项全身因素与IMEM的相关性具有统计学意义(OR＝1.03，2.15；95%CI：1.01~1.05，1.41~3.26；P<0.05)。

结论

腰围大和低密度脂蛋白水平高是60岁以上人群发生IMEM的全身性危险因素。

关键词: 特发性黄斑前膜, 腰围, 低密度脂蛋白, 相关因素
Objective

To explore the systemic risk factors of the idiopathic macular membrane (IMEM) in community population over 60 years old.

Methods

2853 inhabitants (5686 eyes) over 60 years old in Tianzhu Town of Beijing Shunyi District from March 2017 to November 2017 were selected. The data of their physical examination was collected. Among them, there were 1309 males (2600 eyes) and 1544 females (3086 eyes) with the average age of (65.3±4.6) years-old (ranged from 60 to 83 years-old). The questionnaires were including the basic information questionnaire, general physical examination, routine ophthalmic examination, and color fundus photography. The population who meet the IMEM inclusion criteria were defined as the IMEM group; the control group was defined as a 1: 1 randomly selected according to the method of random number table from those with matching sex and age in other inhabitants without IMEM. The age, waist circumference, body mass index, blood pressure, and blood biochemical indices were collected, described by (±s) and compared by independent sample t-test. The gender, daily lifestyle, dietary habit, hypertension history and other systemic chronic diseases were collected, described by the number of cases and percentage, and compared by chi-square test. Logistic regression was used to analyze the systemic factors related to IMEM.

Results

Among of 2853 cases (5686 eyes), there were 177 patients (212 eyes) with IMEM, including 62 males (70 eyes) and 115 females (142 eyes). The average age was (67.5±5.2) years-old (ranged from 60 to 81 years-old). The difference for the waist circumference, systolic blood pressure, low density lipoprotein (LDL) and fasting blood glucose of the two groups were statistically significant (t=-2.73, 2.26, -3.21, 2.13; P<0.05). And the history of hypertension and diabetes had significant statistical difference (χ2 = 4.52, 4.98; P<0.05). By single factor Logistic regression analysis, the correlation between systemic factors such as hypertension history, diabetes history, waist circumference, systolic blood pressure, low-density lipoprotein and fasting blood glucose and IMEM was statistically significant(OR= 0.60, 0.62, 1.03, 0.99, 1.81, 0.91; 95%CI: 0.38 to 0.96, 0.41 to 0.94, 1.01 to1.04, 0.98 to 0.998, 1.25 to 2.63, 0.84 to 0.994; P<0.05). After removing the indicators with collinearity, the correlation between waist circumference and LDL and IMEM was statistically significant through multiple factor Logistic regression analysis(OR= 1.03, 2.15; 95%CI: 1.01 to 1.05, 1.41 to 3.26; P<0.05).

Conclusions

Large waist circumference and high level of LDL are the systemic risk factors for IMEM in people over 60 years old.

Key words: The idiopathic macular membrane, Waist circumference, Low density lipoprotein, Related factors
图1 特发性黄斑前膜的影像学检查图像　图A和图B示以黄斑为中心特发性黄斑前膜的激光扫描眼底照相和无赤光眼底照相；图C和图D示以视盘为中心特发性黄斑前膜的激光扫描眼底照相和无赤光眼底照相；图E示特发性黄斑前膜的光学相干断层扫描图像
表1 两组基本情况的比较
组别 年龄(岁) 腰围(cm) BMI(Kg/m2) 收缩压(mmHg) 舒张压(mmHg) 肌酐( mol/L) 尿素氮(mmol/L) 甘油三酯(mmol/L) 高密度脂蛋白(mmol/L) 低密度脂蛋白(mmol/L) 总胆固醇(mmol/L)
IMEM组 67.53±5.16 91.82±11.78 28.2±6.73 138.79±17.96 82.93±14.6 89.51±32.71 6.26±2.07 1.64±1.18 1.46±0.34 1.92±0.58 4.85±0.92
对照组 67.77 ±4.58 88.31 ±12.31 27.05 ±3.25 143.01 ±18.08 85.92±14.41 86.18±17.58 6.08±1.58 1.57±0.77 1.50±0.43 1.72±0.57 4.80±1.04
t/χ2值 0.47 －2.73 －1.89 2.26 1.93 －1.19 －0.88 －0.57 0.95 －3.21 －0.51
P值 >0.05 <0.05 >0.05 <0.05 >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 >0.05
组别 空腹血糖(mmol/L) 男性[例(%)] 高血压史[例(%)] 糖尿病史[例(%)] 冠心病史[例(%)] 肿瘤[例(%)] 高脂血症[例(%)] 哮喘病史[例(%)] 高盐饮食[例(%)] 吸烟[例(%)] 饮酒[例(%)]
IMEM组 7.25±2.34 62(35.0%) 118(66.7%) 79(44.6%) 24(13.6%) 2(1.1%) 52(29.4%) 5(2.8%) 10(5.6%) 4(2.3%) 6(3.4%)
对照组 7.83±2.77 63(35.6%) 136(76.8%) 100(56.5%) 16(9.0%) 1(0.6%) 40(22.6%) 1(0.6%) 16(9.0%) 5(2.8%) 5(2.8%)
t/χ2值 2.13 0.01* 4.52* 4.98* 1.80* 0.34* 2.12* 2.71* 1.49* 0.11* 0.09*
P值 <0.05 >0.05 <0.05 <0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表2 血液粘滞度相关指标的比较
组别 红细胞压积(%) 红细胞平均体积(fL) 红细胞体积分布宽度(%) 血小板压积(%) 血小板平均体积(fL) 血小板体积分布宽度(%) 血沉(mm/h) 压积(l/l) 全血高切相对指数
IMEM组 42.02±3.38 90.75±4.37 12.59±0.73 0.25±0.06 10.59±0.84 11.94±1.74 5.42±1.97 0.41±0.05 2.32±1.20
对照组 41.98±3.28 90.76±4.70 12.49±0.74 0.25±0.06 10.66±0.92 11.81±1.62 5.28±1.97 0.42±0.03 2.21±0.55
t值 －0.11 0.01 －1.32 1.33 0.79 －0.70 －0.67 1.41 －1.12
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
组别 全血低切相对指数 血沉方程k值 红细胞聚集指数 全血低切还原粘度(mpa·s) 全血高切还原粘度(mpa·s) 红细胞变形指数(tk) 红细胞刚性指数 卡松粘度(mpa·s) 血浆粘度(mpa·s)
IMEM组 11.15±2.69 19.15±7.71 5.05±0.94 36.75±10.78 4.61±2.05 0.70±0.75 3.05±1.62 2.36±1.17 1.52±0.24
对照组 10.66±2.85 18.64±7.90 4.91±0.84 35.32±10.08 4.35±1.81 0.71±0.86 2.87±1.15 2.29±0.51 1.64±0.87
t值 －1.65 －0.61 －1.56 －1.29 －1.29 0.17 －1.21 －0.68 1.75
P值 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
表4 IMEM全身性危险因素多因素Logistic回归分析的结果
项目 高血压史[例(%)] 糖尿病史[例(%)] 腰围(cm) 低密度脂蛋白(mmol/L)
回归系数 －0.42 －0.22 0.03 0.76
标准误 0.26 0.24 0.01 0.21
瓦尔德 2.54 0.89 7.35 12.81
优势比 0.66 0.80 1.03 2.15
95%CI 0.39~1.10 0.51~1.27 1.01~1.05 1.41~3.26
P值 >0.05 >0.05 <0.05 <0.05
表3 IMEM全身性危险因素单因素Logistic回归分析的结果
项目 男性[例(%)] 年龄(岁) 高血压史[例(%)] 糖尿病史[例(%)] 冠心病史[例(%)] 肿瘤病史[例(%)] 高脂血症[例(%)] 哮喘病史[例(%)] 高盐饮食[例(%)] 吸烟[例(%)] 饮酒[例(%)]
回归系数 －0.03 －0.01 －0.51 －0.48 0.46 0.70 0.35 1.63 －0.51 －0.23 0.19
标准误 0.22 0.02 0.24 0.21 0.34 1.23 0.24 1.10 0.42 0.68 0.62
瓦尔德 0.01 0.22 4.48 4.96 1.78 0.32 2.11 2.20 1.47 0.11 0.09
优势比 0.98 0.99 0.60 0.62 1.58 2.01 1.43 5.12 0.60 0.80 1.21
95%CI 0.63~1.51 0.95~1.03 0.38~0.96 0.41~0.94 0.81~3.09 0.18~22.39 0.88~2.30 0.59~44.24 0.27~1.37 0.21~3.01 0.36~4.03
P值 >0.05 >0.05 <0.05 <0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05 >0.05
项目 腰围(cm) BMI(Kg/m2) 收缩压(mmHg) 舒张压(mmHg) 肌酐(mol/L) 尿素氮(mmol/L) 甘油三酯(mmol/L) 高密度脂蛋白(mmol/L) 低密度脂蛋白(mmol/L) 总胆固醇(mmol/L) 空腹血糖(mmol/L)
回归系数 0.03 0.06 －0.01 －0.01 0.01 0.05 0.06 －0.26 0.59 0.06 －0.09
标准误 0.01 0.03 0.01 0.01 0.01 0.06 0.11 0.28 0.19 0.11 0.04
瓦尔德 7.12 3.51 5.00 3.69 1.28 0.77 0.33 0.89 9.80 0.26 4.34
优势比 1.03 1.06 0.99 0.99 1.01 1.05 1.07 0.77 1.81 1.06 0.91
95%CI 1.01~1.04 1.00~1.12 0.98~0.998 0.97~1.007 1.00~1.02 0.94~1.18 0.86~1.32 0.45~1.33 1.25~2.63 0.85~1.31 0.84~0.994
P值 <0.05 >0.05 <0.05 >0.05 >0.05 >0.05 >0.05 >0.05 <0.05 >0.05 <0.05
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