本文選題：開(kāi)角型青光眼 + 發(fā)病率��； 參考：《昆明醫(yī)科大學(xué)》2016年博士論文

【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,原發(fā)性開(kāi)角型青光眼(primary open-angle glaucoma,POAG)是最常見(jiàn)的青光眼類型。POAG因其發(fā)病隱匿,早期診斷困難,即使在發(fā)達(dá)國(guó)家該病的漏診率也高達(dá)50%,多數(shù)患者初次就診時(shí)已經(jīng)伴有明顯的青光眼視神經(jīng)損害,因此對(duì)社會(huì)、經(jīng)濟(jì)影響較大,已成為一個(gè)重要的社會(huì)公共衛(wèi)生問(wèn)題。中國(guó)是世界上青光眼患病人數(shù)最多的國(guó)家,隨著診斷水平的不斷提高,我國(guó)POAG在青光眼中的構(gòu)成比正逐漸增高。中國(guó)是一個(gè)人口大國(guó),而農(nóng)村人口占大多數(shù),同時(shí)地域遼闊,少數(shù)民族聚居,因此對(duì)農(nóng)村少數(shù)民族進(jìn)行POAG的流行病學(xué)調(diào)查也具有非常重要的意義。我國(guó)目前對(duì)青光眼的流行病學(xué)調(diào)查多集中于橫斷面的患病率報(bào)道,而對(duì)于發(fā)病率的研究報(bào)道尚為空白,這是因?yàn)檫M(jìn)行發(fā)病率的研究常需投入較大的人力、物力及財(cái)力；另一方面POAG的發(fā)病特點(diǎn)是發(fā)病隱匿,病程長(zhǎng),診斷困難,且發(fā)病率較低,因此確定其發(fā)病率較為困難。盲和視力損傷是全球性嚴(yán)重的社會(huì)和經(jīng)濟(jì)問(wèn)題,不但嚴(yán)重影響了人民群眾的身體健康和生活質(zhì)量,也給家庭和社會(huì)帶來(lái)了沉重的負(fù)擔(dān)。2010年,wHO發(fā)表了全球視力損傷的最新估計(jì),全球約有中重度視力損傷2.46億人,其中盲人約占3900萬(wàn)。中國(guó)是世界上盲和視力損傷最嚴(yán)重的國(guó)家之一,準(zhǔn)確的盲和視力損傷數(shù)據(jù),有助于國(guó)際衛(wèi)生組織和國(guó)內(nèi)衛(wèi)生機(jī)構(gòu)在制定防盲治盲的衛(wèi)生策略時(shí)可有效、合理的分配有限的衛(wèi)生資源。云南省位于我國(guó)西南部,是我國(guó)社會(huì)經(jīng)濟(jì)發(fā)展較落后的邊疆省份之一,也是我國(guó)擁有少數(shù)民族最多的省份,目前,關(guān)于云南少數(shù)民族眼病的流行病學(xué)資料還是一個(gè)空白。本研究為云南省少數(shù)民族眼病研究的一部分,通過(guò)對(duì)白族和傣族50歲以上農(nóng)村人群POAG和視力損傷的發(fā)病情況進(jìn)行調(diào)查,了解云南省少數(shù)民族地區(qū)可致盲眼病的發(fā)生和防治情況。我們的調(diào)查結(jié)果為今后在云南省及西部邊遠(yuǎn)農(nóng)村和中國(guó)其他少數(shù)民族地區(qū)防盲治盲策略的制定、眼病的早期干預(yù)和公共衛(wèi)生政策的制定提供科學(xué)依據(jù),同時(shí)也有助于針對(duì)性地開(kāi)展農(nóng)村地區(qū)可致盲眼病的疾病防治和健康促進(jìn)工作。第一部分50歲以上農(nóng)村白族原發(fā)開(kāi)角型青光眼5年發(fā)病率隨訪研究[目的]探討中國(guó)農(nóng)村50歲以上白族原發(fā)性開(kāi)角型青光眼(primary open-angle glaucoma,POAG)的5年累積發(fā)病率及其相關(guān)危險(xiǎn)因素,為農(nóng)村地區(qū)原發(fā)性開(kāi)角型青光眼的預(yù)防控制提供循證依據(jù)；[方法]通過(guò)以人群為基礎(chǔ)的隊(duì)列研究,對(duì)2010年曾參與過(guò)青光眼篩查的大理農(nóng)村地區(qū)50歲以上的白族再次進(jìn)行5年后的隨訪檢查,參與者中曾在2010年被查出任何一只眼患有原發(fā)性青光眼者排外,檢查項(xiàng)目包括：視力、眼壓、前房角、視乳頭、杯盤比及視野、眼底照相等,同時(shí)進(jìn)行身高、體重及血糖、血壓測(cè)量,問(wèn)卷調(diào)查全身疾病、受教育程度、吸煙、飲酒情況及青光眼家族史等。青光眼診斷標(biāo)準(zhǔn)采用國(guó)際地域及流行病學(xué)組的診斷標(biāo)準(zhǔn),經(jīng)大理地區(qū)人口統(tǒng)計(jì)學(xué)校正后計(jì)算POAG的5年累積發(fā)病率,并采用多變量回歸模型計(jì)算POAG各相關(guān)危險(xiǎn)因素的比值比(OR)和95%置信區(qū)間(CI);[結(jié)果]1520名曾參與過(guò)基線研究的人群接受了5年期的隨訪檢查,隨訪率達(dá)80.6%；其中原青光眼患者35例排外,新發(fā)POAG患者19例,5年累積發(fā)病率為1.3%(95%CI,0.7-1.9)；POAG的發(fā)病率隨年齡的增長(zhǎng)呈正相關(guān)且具有統(tǒng)計(jì)學(xué)意義(P0.05),發(fā)病率50-59歲為0.4%(95% CI,0.3 to 0.4),60-69歲為0.6%(95% CI,0.5 to 0.7),70歲以上為2.1%(95% CI,1.9-2.3);性別與POAG的發(fā)病無(wú)顯著相關(guān)性,其他相關(guān)的危險(xiǎn)因素包括：眼壓(OR,3.5,95% CI2.0 to 5.9,每10mmHg增加)、垂直杯盤比(OR 9.7,95% CI 2.1 to 45.5,VCDR0.7)及近視(OR 3.6,95% CI 1.4 to 8.9,等效球鏡-0.5D);受教育為保護(hù)因素。[結(jié)論]云南省大理農(nóng)村地區(qū)白族50歲以上人群POAG的發(fā)病率低于非洲裔及大多數(shù)白種人；POAG的發(fā)病率隨年齡的增長(zhǎng)顯著增加,同時(shí)隨眼壓,VCDR,近視度數(shù)的增加發(fā)病率有增加趨勢(shì)；我國(guó)西部邊遠(yuǎn)農(nóng)村地區(qū)POAG的早期診斷和治療率較低,應(yīng)引起政府及相關(guān)衛(wèi)生部門的重視。本項(xiàng)研究結(jié)果對(duì)我國(guó)公共衛(wèi)生部門制定POAG篩查策略,合理分配醫(yī)療資源等方面具有非常重要的指導(dǎo)意義。第二部分傣族和彝族50歲以上農(nóng)村人群盲和視力損傷的流行病學(xué)調(diào)查[目的]調(diào)查云南省傣族和彝族50歲以上農(nóng)村人群盲和視力損傷的患病率、主要病因構(gòu)成及其相關(guān)危險(xiǎn)因素,了解盲和視力損傷的現(xiàn)狀及幾種主要致盲眼病的致盲情況,確定云南省農(nóng)村少數(shù)民族防盲治盲工作的重點(diǎn)防治對(duì)象和重點(diǎn)防治疾病,為云南省農(nóng)村地區(qū)防盲治盲工作的開(kāi)展提供依據(jù)。[方法]采用以人群為基礎(chǔ)的橫斷面調(diào)查對(duì)西雙版納和石林縣農(nóng)村50歲以上的傣族和彝族人群進(jìn)行可致盲眼病的篩查。檢查內(nèi)容包括視力檢查、驗(yàn)光、眼前段檢查、眼底檢查,必要時(shí)測(cè)量眼壓。視力檢查使用糖尿病視網(wǎng)膜病變?cè)缙谥委熝芯恳暳Ρ?進(jìn)行日常生活視力(presenting visual acuity,PVA)和最佳矯正視力(best-corrected visual acuity, BCVA)檢查。根據(jù)檢查結(jié)果對(duì)所有PVA0.3的眼做出引起盲和視力損傷的主要眼病的診斷。分別以PVA和BCVA為標(biāo)準(zhǔn),計(jì)算引起盲和視力損傷的眼病構(gòu)成比。[結(jié)果]一、傣族眼病調(diào)查結(jié)果1.共2163名傣族接受了檢查,排除其中不能完成視力檢查的13人,最終2150名傣族納入本次調(diào)查統(tǒng)計(jì)分析,受檢率為80.5%。各個(gè)年齡段的受檢率不一致,隨著年齡的增加受檢率增加;女性的受檢率明顯高于男性;受教育水平對(duì)受檢率影響不明顯。2.按BCVA計(jì)算,盲46例,患病率為2.14%,視力損傷145例,患病率為6.74%;按PVA計(jì)算,盲64例,患病率為2.98%,視力損傷287例,患病率為13.35%.校正性別和受教育程度后,BCVA和PVA所得盲的相對(duì)危險(xiǎn)度均隨著年齡增加而增加;校正年齡和受教育程度后,男性盲的患病率高于女性。低水平的受教育程度相對(duì)高水平受教育程度發(fā)生視力損傷的危險(xiǎn)性增加,但差異無(wú)統(tǒng)計(jì)學(xué)意義。3.按人數(shù)計(jì)算,以BCVA為標(biāo)準(zhǔn),傣族引起盲的前三位主要眼病依次為白內(nèi)障(73.91%),青光眼(8.7%)和高度近視黃斑病變(6.52%)；引起視力損傷的前三位主要眼病依次為白內(nèi)障(66.90%)、年齡相關(guān)性黃斑病變(Age-related Macular Degeneration,AMD)(11.03%)和高度近視黃斑病變(7.59%)。以PVA為標(biāo)準(zhǔn),引起盲的前三位主要眼病依次為白內(nèi)障(68.25%)、高度近視黃斑病變(9.52%)和青光眼(6.35%);引起視力損傷的前三位主要眼病依次為白內(nèi)障(62.98%)、屈光不正(11.76%)和年齡相關(guān)性黃斑病變(6.57%)。二、彝族眼病調(diào)查結(jié)果1.共2214名彝族接受了檢查,排除其中不能完成視力檢查的6人,最終2208名彝族納入本次調(diào)查統(tǒng)計(jì)分析,受檢率為81.0%。各個(gè)年齡段的受檢率不一致,隨著年齡的增加受檢率增加;女性的受檢率明顯高于男性;受教育水平對(duì)受檢率影響不明顯。2.按BCVA計(jì)算,盲38例,患病率為1.7%,視力損傷180例,患病率為8.2%;按PVA計(jì)算,盲46例,患病率為2.1%,視力損傷422例,患病率為19.1%.校正性別和受教育程度后,BCVA和PVA所得盲的相對(duì)危險(xiǎn)度均隨著年齡增加而增加。低水平的受教育程度相對(duì)高水平受教育程度發(fā)生視力損傷和盲的危險(xiǎn)性增加。3.按人數(shù)計(jì)算,以BCVA為標(biāo)準(zhǔn),彝族引起盲的前三位主要眼病依次為白內(nèi)障(71.1%),年齡相關(guān)性黃斑病變(10.5%)和角膜混濁(5.3%)；引起視力損傷的前三位主要眼病依次為白內(nèi)障(66.7%)、高度近視黃斑病變(7.8%)和年齡相關(guān)性黃斑病變(6.7%)。以PVA為標(biāo)準(zhǔn),引起盲的前三位主要眼病依次為白內(nèi)障(63.0%)、年齡相關(guān)性黃斑病變(10.9)和高度近視黃斑病變(6.5%);引起視力損傷的前三位主要眼病依次為白內(nèi)障(69.4%)、屈光不正(7.6%)和年齡相關(guān)性黃斑病變(4.5%)。[結(jié)論]傣族和彝族50歲以上農(nóng)村人群盲和視力損傷的患病率高于國(guó)內(nèi)多數(shù)漢族地區(qū)的眼病調(diào)查結(jié)果。致盲和視力損傷的主要原因?yàn)榘變?nèi)障,使用PVA時(shí),屈光不正是視力損傷的第二位原因；矯正屈光不正后,年齡相關(guān)性黃斑病變?yōu)橐暳p傷的第二位原因。少數(shù)民族地區(qū)農(nóng)村人群盲和視力損傷的原因中大多是可避免或者可預(yù)防的,防盲治盲的重點(diǎn)應(yīng)放在自內(nèi)障的治療上,同時(shí)應(yīng)關(guān)注屈光不正的矯正。傣族和彝族盲的患病率均隨年齡增加而增加。本調(diào)查結(jié)果對(duì)我國(guó)邊疆少數(shù)民族地區(qū)開(kāi)展防盲治盲工作具有重要的指導(dǎo)意義。
[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.
【學(xué)位授予單位】：昆明醫(yī)科大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2016
【分類號(hào)】：R775

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