云南省汉族和彝族50岁以上人群原发性青光眼5年随访研究

Primary glaucoma which includes primary open angle glaucoma and primary angle-closure glaucoma is the main type of glaucoma, but primary angle-closure glaucoma has far higher prevalence rates in China than in European and American countries，and it is also a disease with high blindness and can severely damage visual function . Because the pathogenesis of primary glaucoma is not clear，the development of its natural history has been a big problem which need to be solved urgently in clinical. The mechanisms,interrelationships,clinical diagnosis and treatment standard among hypertension primary open angle glaucoma,normal tension glaucoma and ocular hypertension has not to be clear. For primary angle-closure glaucoma, researchers have proposed the theory that revealing the course from primary angle-closure suspect to primary angle-closure and finally to primary angle-closure glaucoma，but the concept has not been recognized because of lack of enough evidences which need follow up long time and large samples. In the previous study，we have completed the glaucoma epidemiological investigation among the population whose age is over fifty years old people in han nationality and minorities in Yunnan province and then concluding the glaucoma epidemiological data that following international standards . This study will process longitudinal follow-up to this population in five years , after exploring the natural history of different types of glaucoma, evaluating the changing characteristics of visual function and screening effect ,we can provide the evidence to build the new system of primary glaucoma including classification, screening, diagnosis, treatment and evaluation.

原发性青光眼（包括开角型和闭角型）是我国主要的青光眼类型，其中闭角型青光眼患病率远高于欧美国家，并且是一种致盲率很高且严重破坏视功能的病。由于发病机制尚不明确，原发性青光眼的自然病程的发展是临床亟需解决的一大难题。开角型青光眼中高眼压型和正常眼压型还有高眼压症的机制和相互关系、临床诊断和治疗标准都未有定论，而对于闭角型青光眼国外学者提出了从可疑房角关闭、原发性房角关闭发展到原发性闭角型青光眼的学说，但这一结果还缺乏足够的大样本长期随访证据，尚未得到公认。我们在前期研究中完成了云南省汉族和少数民族50岁以上人群的青光眼流行病学调查，得出了遵循国际标准的青光眼流行病学资料。本研究在随后5年中对这一人群进行纵向的随访，探索不同类型青光眼的自然病程，评估视功能变化特点和筛查效果，为建立我国的原发性青光眼的分类、筛查、诊断、治疗和评价体系提供循证依据。

为探讨云南省50岁以上农村少数民族原发性青光眼的5年累积发病率及其相关危险因素，明确青光眼对盲和视力损伤的影响，进而为防盲治盲工作的开展提供依据，我们采用队列研究的方法，对白族、 傣族、彝族和汉族人群进行5年期的随访调查，随访眼病包括青光眼、导致盲和视力损伤的主要眼病，计算青光眼的5年累积发病率及各相关危险因素，同时对各少数民族盲和视力损伤情况进行比较。通过调查我们得到了白族POAG的5年发病率是1.3%, POAG的发病率随年龄的增长呈正相关且具有统计学意义（P<0.05），发病率50-59岁为0.4%，60-69岁为0.6%，70岁以上为2.1%；性别与POAG的发病无显著相关性，其他相关的危险因素包括：眼压、垂直杯盘比及近视；受教育为保护因素。通过比较，男性、彝族、高眼压和近视与原发性开角型青光眼的发病呈正相关。白族翼状胬肉的5年累积发病率为6.8%，女性显著高于男性。50-59岁，60~69岁，70岁及以上年龄组的发病率分别为7.7%，6.5%，和5.6%。户外活动是唯一的、显著的相关因素。傣族和彝族50岁以上农村人群盲和视力损伤的患病率高于国内多数汉族地区的眼病调查结果，傣族和彝族盲的患病率均随年龄增加而增加。白内障（53.0%）和未矫正的屈光不正（22.0%）是视力损伤（PVA）首要原因。本调查发现云南省大理农村地区白族50岁以上人群POAG的发病率低于非洲裔及大多数白种人；POAG的发病率随年龄的增长显著增加，同时随眼压，VCDR，近视度数的增加发病率有增加趋势；我国西部边远农村地区POAG的早期诊断和治疗率较低；傣族和彝族50岁以上农村人群盲和视力损伤的患病率高于国内多数汉族地区的眼病调查结果；少数民族地区农村人群盲和视力损伤的原因中大多是可避免或者可预防的，防盲治盲的重点应放在白内障的治疗上，同时应关注屈光不正的矫正；傣族和彝族盲的患病率均随年龄增加而增加。本项研究结果对我国公共卫生部门制定防盲治盲筛查策略，合理分配医疗资源等方面具有非常重要的指导意义。