本文選題：玻璃體黃斑界面疾病　切入點(diǎn)：住院患者　出處：《上海交通大學(xué)》2015年博士論文

【摘要】：背景:玻璃體黃斑界面(vitreomacular interface,VMI)疾病是一類由于VMI病理改變而引起的年齡相關(guān)性退行性病變,主要包括黃斑前膜(epiretinal membrane,ERM)、黃斑裂孔(macular hole,MH)、玻璃體黃斑牽引綜合征(vitreomacular traction syndrome,VTS)、黃斑劈裂等。本課題組前期研究發(fā)現(xiàn),VMI疾病已成為本院眼科手術(shù)量的第三位,是威脅老年人視覺質(zhì)量的重要因素。控制VMI疾病的關(guān)鍵在于預(yù)防,而預(yù)防的關(guān)鍵在于明確其發(fā)病規(guī)律及其危險(xiǎn)因素。然而,目前國(guó)內(nèi)外尚缺乏這方面的研究報(bào)告。目的:分析近5年來(lái)本院眼科收治VMI疾病患者臨床資料,初步篩選出與VMI疾病發(fā)生相關(guān)的危險(xiǎn)因素。方法:(1)回顧性收集2010年1月至2014年12月本院眼科收治的VMI疾病患者臨床資料,包括性別、年齡、主要診斷、其他診斷等,對(duì)以上資料進(jìn)行統(tǒng)計(jì)分析,深入挖掘VMI疾病總體及各類病種患者特征;(2)回顧性收集2014年1月至2014年12月本院眼科收治入院的VMI疾病患者臨床資料,并收集健康體檢中心接受健康體檢者臨床資料作為對(duì)照組。對(duì)所有入選研究對(duì)象進(jìn)行詳細(xì)的眼科檢查和病史收集,收集的病史資料包括:學(xué)歷,抽煙、飲酒習(xí)慣,屈光狀態(tài),糖尿病、高血壓及高脂血癥等全身疾病史。并取血清進(jìn)行性激素六項(xiàng)檢測(cè),包括:卵泡刺激素(FSH)、黃體生成激素(LH)、雌二醇(E2)、孕酮(P)、睪酮(T)及催乳素(PRL);(3)對(duì)以上計(jì)數(shù)資料采用卡方檢驗(yàn);對(duì)正態(tài)分布的計(jì)量資料采用獨(dú)立樣本t檢驗(yàn);對(duì)非正態(tài)分布的計(jì)量資料采用非參數(shù)檢驗(yàn)進(jìn)行組間比較,篩選出有統(tǒng)計(jì)學(xué)意義的變量,進(jìn)行多因素非條件Logistic回歸分析。結(jié)果:(1)近5年來(lái),本院眼科收治入院的VMI疾病患者共979例,男性患者共287例,女性患者共692例,男女比例為1:2.4。近5年VMI疾病患者平均年齡61.6歲,其中男性患者62.3歲,女性患者61.4歲。男女性患者年齡分布情況不同:男性患者的發(fā)病率增高趨勢(shì)較為緩和,總體呈現(xiàn)隨年齡增長(zhǎng),發(fā)病率增高;而女性患者呈現(xiàn)絕經(jīng)后發(fā)病率陡增的特點(diǎn),集中分布于56~65歲年齡段。近5年主要診斷為特發(fā)性ERM、特發(fā)性MH及VTS的患者分別為454例、502例及24例,各病種歷年患者量均呈現(xiàn)上升趨勢(shì);男女比例分別為1:2.3、1:2.4、1:3.8,男女性VMI疾病患者病譜構(gòu)成情況類似。合并高血壓、II型糖尿病的VMI疾病患者分別占11.5%、3.5%;(2)危險(xiǎn)因素分析共納入VMI疾病患者73例,男性患者20例,女性患者53例,平均年齡為63.4歲;男性患者中,IERM、IMH、VTS分別為9例、11例、1例;女性患者中,IERM、IMH、VTS分別為27例、23例、3例。單因素分析結(jié)果顯示:男性VMI疾病患者以上各項(xiàng)研究因素與對(duì)照組差異均不顯著;女性VMI疾病患者血清雌二醇(estrodiol,E2)、孕酮(progesterone,P)、催乳素(prolactin,PRL)及睪酮(testosterone,T)水平均顯著低于對(duì)照組;對(duì)不同病種女性VMI疾病患者進(jìn)一步進(jìn)行分析,女性IERM及IMH患者分別在血清E2、T及E2、P、T水平上顯著低于對(duì)照組。結(jié)論:近5年來(lái),本院眼科VMI疾病收治量逐年穩(wěn)步遞增。絕經(jīng)后早期女性最為高發(fā),男性患者發(fā)病晚于女性,且發(fā)病率隨年齡增高而上升。女性VMI疾病患者多項(xiàng)性激素水平顯著低于對(duì)照組,E2與T尤為明顯;未發(fā)現(xiàn)男性VMI疾病顯著危險(xiǎn)因素,提示男女性VMI疾病發(fā)病機(jī)制可能存在差異。
[Abstract]:Background: vitreous body interface (vitreomacular interface, VMI macular disease) is a kind of age-related degenerative lesions due to pathological changes caused by VMI, including macular epiretinal membrane (epiretinal, membrane, ERM), macular hole (macular hole, MH), vitreous body macular traction syndrome (vitreomacular traction, syndrome, VTS). Macular retinoschisis. Previous studies showed that VMI disease has become the hospital surgical volume of third, is an important factor threatening the visual quality of the elderly. The key control of VMI disease is prevention, and prevention is the key to clear the pathogenesis and risk factors. However, there is still lack of research report both at home and abroad. Objective: to analyze the past 5 years in our hospital were VMI disease patients with clinical data, preliminary screening risk factors associated with VMI disease. Methods: (1) were collected from January 2010 to The clinical data of patients with VMI disease from December 2014 in our hospital including gender, age, primary diagnosis, diagnosis, and statistical analysis of the above information, dig the overall VMI disease and all kinds of disease characteristics; (2) clinical data of patients with VMI disease were retrospectively collected from January 2014 to December 2014, the hospital admitted to hospital, and collect the health examination center received physical examination as the control group. The clinical data of detailed ophthalmologic examination and history collection of all subjects, history data collection including: education, smoking, drinking habits, refractive status, diabetes, hypertension and hyperlipidemia history of systemic diseases. And serum sex hormone six testing, including: follicle stimulating hormone (FSH), luteinizing hormone (LH), estradiol (E2) and progesterone (P), testosterone (T) and prolactin (PRL); (3) the count data by chi square test ; independent samples t test was used for measurement data of normal distribution; the non normal distribution of the measurement data using non parametric test for comparison between groups, were statistically significant variables, multivariate non conditional Logistic regression analysis. Results: (1) in the past 5 years, the hospital admitted to hospital VMI disease patients with a total of 979 cases of male patients with a total of 287 cases of female patients in 692 cases, the ratio of male to female was nearly 5 years of 1:2.4. VMI disease patients with an average age of 61.6 years, of which 62.3 were male, female patients 61.4 years of age. Men and women of different age distribution of patients: the incidence of male patients were significantly increased in the trend of more moderate, generally with the increase of age, the increased incidence of female patients; and has the characteristics of incidence sharply after menopause, concentrated in the 56~65 years of age. The last 5 years for the diagnosis of idiopathic ERM, idiopathic MH and VTS patients were 454 cases, 502 cases and 24 Cases of various diseases over the years were increased; the proportion of men and women were 1:2.3,1:2.4,1:3.8, a similar spectrum of male and female VMI patients. Patients with hypertension, type II diabetes patients with VMI disease accounted for 11.5%, 3.5%; (2) risk factors included 73 patients with VMI disease, 20 cases of male patients. 53 cases of female patients, the average age is 63.4 years old; male patients, IERM, IMH, VTS were 9 cases, 11 cases, 1 cases; female patients, IERM, IMH, VTS were 27 cases, 23 cases, 3 cases. Univariate analysis showed that the factors of male VMI difference with control group. The studies above patients were not significant; female serum estradiol in patients with VMI disease (estrodiol, E2), progesterone (progesterone, P), prolactin (prolactin, PRL) and testosterone (testosterone, T) was significantly lower than the control group; the patients with different diseases of female VMI disease further analysis, female IERM And IMH patients respectively in serum E2, T and E2, P, T level was significantly lower than the control group. Conclusion: in the past 5 years, our hospital ophthalmology VMI disease steadily increasing. The high incidence of early postmenopausal women, the incidence of male patients than female, and the incidence rate increased with age and increased number. The sex hormone levels in female patients with VMI disease were significantly lower than the control group, E2 and T is obvious; no significant risk factors found in male VMI disease, suggesting that the male and female VMI disease mechanisms are different.

【學(xué)位授予單位】：上海交通大學(xué)
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R774.5

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