本文選題：年齡相關(guān)白內(nèi)障　切入點(diǎn)：吸煙　出處：《遼寧醫(yī)學(xué)院》2012年碩士論文　論文類型：學(xué)位論文

【摘要】：目的 調(diào)查中老年人群年齡相關(guān)白內(nèi)障（Age-related cataract，ARC）的流行病學(xué)現(xiàn)狀，探討年齡相關(guān)白內(nèi)障的社會(huì)人口學(xué)特征、生活方式因素（吸煙、飲酒）與年齡相關(guān)白內(nèi)障發(fā)病的關(guān)系。 方法 研究對象為2010年4月～2011年10月，在錦州市的三級甲等醫(yī)院眼科病房住院，臨床診斷為ARC，并實(shí)施手術(shù)治療，術(shù)后經(jīng)病理檢驗(yàn)證實(shí)為ARC的360例患者，年齡為45~85歲。對照為同期住院的非ARC患者組成，病例與對照以1：1方式進(jìn)行匹配。采用標(biāo)準(zhǔn)調(diào)查表對所有研究對象進(jìn)行調(diào)查，調(diào)查內(nèi)容包括人口學(xué)特征、生活方式（吸煙、飲酒）、膳食攝入情況、可能與ARC有關(guān)的疾病既往史及生化指標(biāo)等因素，同時(shí)對研究對象進(jìn)行身高、體重、腰圍及臀圍的測量。采用SPSS13.0統(tǒng)計(jì)分析軟件，對所調(diào)查資料進(jìn)行分析，以確定吸煙、飲酒與ARC之間的關(guān)系。 結(jié)果 1、本研究共收集病例和對照各360例，病例組年齡為45~85歲，平均（69.65±10.89）歲，其中女性174名（48.33%）。對照組年齡為45~85歲，平均（69.23±10.34）歲,其中女性174名（48.33%）。病例與對照均為當(dāng)?shù)鼐幼?0年以上的常住人口。對兩組研究對象的一般人口學(xué)特征進(jìn)行均衡性檢驗(yàn)的結(jié)果顯示，2組研究對象的年齡（χ2=1.599，P=0.660）、性別（χ2=0.000，P=1.000）、民族（χ2=0.196，P=0.973）、居住地（χ2=2.920，P=0.232）、文化程度（χ2=6.225，P=0.101）、職業(yè)（χ2=3.125，P=0.373）分布的差異均無統(tǒng)計(jì)學(xué)意義。 2、病例和對照吸煙史分布的差異具有統(tǒng)計(jì)學(xué)意義（χ2=6.246，P=0.044）,206例（57.22%）病例為現(xiàn)行吸煙者（36.39%）和曾吸煙者（20.83%），175例（48.61%）對照為現(xiàn)行吸煙者（28.61%）和曾吸煙者（20.00%）。病例組高于對照組。 3、2組研究對象飲酒史分布的差異也具有統(tǒng)計(jì)學(xué)意義（χ2=6.675，P=0.036），分別有113例（31.39%）和16例（4.44%）病例為現(xiàn)行飲酒者和曾飲酒者，而對照中現(xiàn)行飲酒者和曾飲酒者分別為142例（39.44%）和21例（5.83%）。病例組低于對照組。 4、吸煙狀況與ARC的關(guān)系 調(diào)整多因素后吸煙與年齡相關(guān)白內(nèi)障關(guān)聯(lián)的OR及其95%CI的結(jié)果表明：病例和對照吸煙史分布的差異具有統(tǒng)計(jì)學(xué)意義（χ2=6.246，P=0.044），與從不吸煙的對照相比較，現(xiàn)行吸煙（OR=1.817，95%CI：1.323~2.479，P=0.005）和曾吸煙（OR=1.295，95%CI：0.847~1.943，P=0.203）的病例發(fā)生ARC的危險(xiǎn)性均升高，但僅現(xiàn)行吸煙者具有統(tǒng)計(jì)學(xué)意義。與從不吸煙的對照相比較，現(xiàn)行吸煙20~30支/d（OR=2.102，95%CI：1.226~3.508，P=0.003）和≥30支/d（OR=2.303，95%CI：1.194~4.235，P=0.012）的病例發(fā)生ARC的危險(xiǎn)性明顯升高，吸煙量越大，發(fā)生ARC的危險(xiǎn)性越高。曾吸煙者的每日吸煙量與ARC無關(guān)。吸煙1~20年、20~30年和≥30年的病例發(fā)生ARC的危險(xiǎn)性分別是從不吸煙對照的1.431（95%CI：1.005~2.038，P=0.047）、1.836（95%CI：1.121~2.896，P=0.022）和2.081倍（95%CI：1.685~3.627，P=0.001）。將戒煙時(shí)間分為20和≥20年后，進(jìn)行分析的結(jié)果顯示，與從不吸煙者相比，戒煙≥20年者發(fā)生ARC的危險(xiǎn)性約下降27%（OR=0.729，95%CI：0.341~0.969，P=0.027）。 5、飲酒狀況與ARC的關(guān)系 2組研究對象飲酒史分布的差異具有統(tǒng)計(jì)學(xué)意義（χ2=6.675，P=0.036）。與從不飲酒的對照相比較，現(xiàn)行飲酒的病例發(fā)生ARC的危險(xiǎn)性顯著下降（OR=0.539，95%CI：0.284~0.979，P=0.018），雖然曾飲酒者發(fā)生ARC的危險(xiǎn)性也下降，但差異無統(tǒng)計(jì)學(xué)意義（OR=0.755，95%CI：0.544~1.048，P=0.093）。隨著每日酒精攝入量的增加，ARC的發(fā)病危險(xiǎn)性并不呈一致性的降低，與從不飲酒者比較，酒精攝入量45~60g/d （OR=1.331，95%CI：0.842~2.430，P=0.572）和≥60g/d（OR=1.714，95%CI：1.051~3.130，P=0.024）者發(fā)生ARC的危險(xiǎn)性升高，飲酒的保護(hù)作用降低，酒精攝入量與ARC發(fā)病危險(xiǎn)性呈U型關(guān)系。本研究并未發(fā)現(xiàn)飲酒的年限與ARC相關(guān)聯(lián)的證據(jù)。 對飲用酒的類型和數(shù)量與ARC的關(guān)聯(lián)性進(jìn)行分析的結(jié)果顯示：飲用任何類型酒≥4標(biāo)準(zhǔn)杯/d的病例發(fā)生ARC的危險(xiǎn)性比從不飲酒的對照升高72%（OR=1.719，95%CI：1.034~2.930，P=0.027）。飲用烈性酒1~4標(biāo)準(zhǔn)杯/d的研究對象發(fā)生ARC的危險(xiǎn)性下降了約一半（OR=0.466，95%CI：0.264~0.823，P=0.008），而≥4標(biāo)準(zhǔn)杯/d卻可使發(fā)生ARC的危險(xiǎn)性升高（OR=1.641，95%CI：1.027~3.023，P=0.039）。飲用啤酒與發(fā)生ARC的危險(xiǎn)性無關(guān)。飲用葡萄酒1~4標(biāo)準(zhǔn)杯/d和≥4標(biāo)準(zhǔn)杯/d均與ARC呈顯著性負(fù)相關(guān)（分別有OR=0.537，95%CI：0.166~0.968，P=0.032和OR=0.609，95%CI：0.230~0.974，P=0.016）。 6、吸煙并飲酒與ARC的關(guān)系 調(diào)整多種潛在性混雜因素后，不同吸煙狀況的研究對象酒精攝入量與ARC的關(guān)系不同，現(xiàn)行吸煙又重度飲酒者（≥45g/d）發(fā)生ARC的危險(xiǎn)性顯著升高，是現(xiàn)行吸煙但從不飲酒者的2.149倍（OR=2.149，95%CI：1.132~3.936，P=0.020）。戒煙者中，與從不飲酒者相比較，，酒精攝入量45g/d與ARC呈顯著性負(fù)相關(guān)（OR=0.453，95%CI：0.223~0.921，P=0.029），酒精攝入量≥45g/d者發(fā)生ARC的危險(xiǎn)性升高，但差異無統(tǒng)計(jì)學(xué)意義（OR=1.418，95%CI：0.813~3.452，P=0.146）。 結(jié)論 1、吸煙是ARC的危險(xiǎn)因素，吸煙量與ARC呈正相關(guān)，吸煙時(shí)間與ARC呈正相關(guān)，戒煙可使發(fā)生ARC的危險(xiǎn)性下降。 2、飲酒與ARC的發(fā)病存在相關(guān)關(guān)系，與從不飲酒的對照相比較，現(xiàn)行飲酒的病例發(fā)生ARC的危險(xiǎn)性下降。飲酒量與ARC發(fā)病危險(xiǎn)性呈U型關(guān)系。本研究并未發(fā)現(xiàn)飲酒的年限與ARC相關(guān)聯(lián)的證據(jù)。 3、飲用烈性酒≥4標(biāo)準(zhǔn)杯/d可使發(fā)生ARC的危險(xiǎn)性升高，飲用啤酒與發(fā)生ARC的危險(xiǎn)性無關(guān)，飲用葡萄酒與ARC呈顯著性負(fù)相關(guān)。 4、現(xiàn)行吸煙又重度飲酒者發(fā)生ARC的危險(xiǎn)性顯著升高。 5、戒煙者中，與從不飲酒者相比較，酒精攝入量45g/d與ARC呈顯著性負(fù)相關(guān)，酒精攝入量≥45g/d者發(fā)生ARC的危險(xiǎn)性升高， 吸煙、飲酒可能會(huì)對中老年發(fā)生白內(nèi)障的危險(xiǎn)性產(chǎn)生實(shí)質(zhì)性影響。探討吸煙、飲酒與白內(nèi)障發(fā)生發(fā)展的關(guān)系，確定吸煙、飲酒是白內(nèi)障的危險(xiǎn)因素還是保護(hù)性因素。為高危人群提供關(guān)于發(fā)生白內(nèi)障的危險(xiǎn)因素的理論根據(jù)，以及提供他們改變這些危險(xiǎn)因素，降低發(fā)生白內(nèi)障危險(xiǎn)性的措施。如果這一調(diào)查結(jié)果能在我國白內(nèi)障患病的人群中得到證實(shí)，就應(yīng)當(dāng)倡導(dǎo)不吸煙，吸煙的人群戒煙、適度飲酒，保持健康的生活方式，這無疑會(huì)降低ARC發(fā)病的危險(xiǎn)性。
[Abstract]:objective
Objective to investigate the epidemiological status of Age-related cataract (ARC) among middle-aged and elderly people, to explore the social demographic characteristics of age related cataract, and the relationship between lifestyle factors (smoking and drinking) and the incidence of age-related cataract.
Method
The object of the study is from April 2010 to October 2011, in the ophthalmology ward three grade a hospital in Jinzhou City, a clinical diagnosis of ARC, and the implementation of surgical treatment, postoperative pathology confirmed 360 cases of ARC patients, aged 45~85 years old. The control group for the same period in non ARC patients, cases and controls with 1:1 method matching. By using a structured questionnaire to investigate all the research object, questionnaire including demographic characteristics, lifestyle (smoking, drinking), dietary intake, may be associated with ARC disease history and biochemical indexes and other factors, at the same time the study object of height, weight, waist circumference and hip circumference measurement. Using SPSS13.0 statistical analysis software the investigation, data analysis, to determine the relationship between smoking, drinking and ARC.
Result
This study collected a total of 1, and the control of the 360 cases, patients aged 45~85 years old, the average (69.65 + 10.89) years old, including 174 women (48.33%). The control group were 45~85 years old, the average (69.23 + 10.34) years old, including 174 women (48.33%). The cases and controls for when the resident population of more than 10 years of residence. The general demographic characteristics of two groups of subjects were balanced test results indicated that the 2 groups of subjects age (x 2=1.599, P=0.660), gender (2=0.000, P=1.000), national (x 2=0.196, P=0.973), where (x 2=2.920, P=0.232). The culture degree (x 2=6.225, P=0.101), occupation (2=3.125, P=0.373) the distribution of the difference was not statistically significant.
2, the difference of smoking history distribution between cases and controls was statistically significant (chi 2=6.246, P=0.044), and 206 cases (57.22%) were current smokers (36.39%) and smokers (20.83%), 175 cases (48.61%) were smokers (28.61%) and smokers (20%). The case group was higher than that of the control group.
The 3,2 group studied history of alcohol consumption between the distribution was also statistically significant (2=6.675, P=0.036), there were 113 cases (31.39%) and 16 cases (4.44%) were current drinkers and had drinkers, whereas current drinkers and drinkers had respectively 142 cases (39.44%) and 21 cases (5.83% cases). Group than the control group.
4, the relationship between smoking status and ARC
OR and 95%CI smoking and age related cataract after adjusting the results show that the difference between cases and controls the distribution of smoking was statistically significant (2=6.246, P=0.044), and compared to never smokers, current smoking (OR=1.817,95%CI:1.323~2.479, P=0.005) and former smokers (OR=1.295,95%CI:0.847~1.943, P=0.203) dangerous cases ARC were increased, but the only current smokers were statistically significant. Compared with never smokers on smoking, current 20~30 /d (OR=2.102,95%CI:1.226~3.508, P=0.003) and more than 30 /d (OR=2.303,95%CI:1.194~4.235, P=0.012) the risk of ARC cases increased significantly, the greater the amount of smoking, the risk of ARC is higher. Daily smoking and smoking. Smokers had ARC 1~20 years, 20~30 years and the risk of more than 30 years were ARC respectively is never smoking on According to the 1.431 (95%CI:1.005~2.038, P=0.047), 1.836 (95%CI:1.121~2.896, P=0.022) and 2.081 times (95%CI:1.685~3.627, P=0.001). The smoking time is divided into 20 after 20 years and above, the analysis results showed that compared with never smokers, the risk of smoking more than 20 years has decreased about 27% ARC (OR=0.729,95%CI:0.341~0.969, P=0.027).
5, the relationship between drinking status and ARC
The 2 groups studied the history of alcohol consumption between the distribution was statistically significant (2=6.675, P=0.036). And never drink compared to the control, the risk of the occurrence of cases of current drinking ARC decreased significantly (OR=0.539,95%CI:0.284~0.979, P=0.018), although the risk has occurred ARC drinkers also decreased, but the difference was not statistically significant (OR=0.755,95%CI:0.544~1.048. P=0.093). With the increase of daily alcohol intake and the risk of ARC is not a lower consistency, compared with never drinkers, alcohol intake (OR=1.331,95%CI:0.842~ 2.430, 45~60g/d P=0.572) and 60g/d (OR=1.714,95%CI:1.051~3.130, P=0.024) the risk of occurrence of the increase of ARC, reduce the protective effect of drinking, alcohol intake was U type relationship and the risk of ARC. This study shows that the duration of drinking are associated with the ARC evidence.
Related to drinking wine and the type and quantity of ARC analysis results showed that the control risk of any type of drinking wine is more than 4 standard cup /d cases occurred ARC than never drinkers increased 72% (OR=1.719,95%CI:1.034~2.930, P=0.027). The risk of the research object of drinking liquor 1~4 standard /d ARC drop cup about half (OR=0.466,95%CI:0.264~0.823, P=0.008), and more than 4 standard cup /d can make the risk of ARC increased (OR=1.641,95%CI:1.027~3.023, P=0.039). Drinking beer has nothing to do with the risk of ARC. Wine standard 1~4 drinking cup /d cup and above 4 standard /d and ARC were significantly negatively correlated (respectively. OR=0.537,95%CI:0.166~0.968, P=0.032 and OR=0.609,95%CI:0.230~0.974, P=0.016).
6, the relationship between smoking and drinking with ARC
The adjustment for multiple potential confounding factors, the relationship between different research objects on smoking status, alcohol intake and ARC, current smoking and heavy drinkers (more than 45g/d) significantly increased the risk of ARC, is the current smoking but never drinkers 2.149 times (OR=2.149,95%CI:, 1.132~3.936, P=0.020). Smokers compared with never drinkers., a significant negative correlation between alcohol intake and 45g/d ARC (OR=0.453,95%CI:0.223~0.921, P=0.029), the risk of alcohol intake was larger than 45g/d ARC increased, but the difference was not statistically significant (OR=, 1.418,95%CI:0.813~3.452, P=0.146).
conclusion
1, smoking is a risk factor for ARC, the amount of smoking is positively correlated with ARC, and the time of smoking is positively related to ARC. Smoking cessation can reduce the risk of ARC.
2, alcohol consumption is associated with the incidence of ARC. Compared with those who never drank alcohol, the risk of ARC is decreasing. The relationship between alcohol consumption and the risk of ARC is U type.
3, drinking liquor is more than 4 standard drinks /d can increase the risk of ARC increased, drinking beer has nothing to do with the risk of ARC, a significant negative correlation between drinking Wine and ARC.
4, there is a significant increase in the risk of ARC in the current and severe drinkers.
5, smokers, compared with never drinkers, a significant negative correlation between alcohol intake and 45g/d ARC, the risk of alcohol intake was larger than 45g/d ARC,
Smoking and drinking may have a substantial impact on the risk of elderly cataract. To investigate the relationship between smoking, drinking, and cataract development identified smoking, drinking were risk factors of cataract or protective factors. The risk factors for high risk population to provide the theoretical basis on the occurrence of cataract, and provide them to change these risk factors to reduce the risk of cataract, measures. If the findings can be confirmed in our country of cataract in the crowd, we should advocate not smoking, smokers quit smoking, moderate alcohol consumption, maintaining a healthy lifestyle, which will undoubtedly reduce the incidence of ARC.

【學(xué)位授予單位】：遼寧醫(yī)學(xué)院
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2012
【分類號】：R776.1

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相關(guān)期刊論文 前2條

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2 馬德環(huán),葉冬青,陳逖;老年性白內(nèi)障危險(xiǎn)因素病例對照研究[J];臨床眼科雜志;2001年04期

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