摘要目的 探讨温州地区原发性开角型青光眼(POAG)患者视野缺损进展的危险因素.方法 前瞻性巢式病例对照研究.收集2014年3月至2018年4月于温州医科大学附属眼视光医院进行的温州青光眼进展研究中确诊的POAG患者,随访中观察患者视野缺损进展情况,采用青光眼进展分析法将患眼分为视野缺损进展组和视野缺损非进展组.采用Lenstar眼科光学生物仪测量眼轴长度和中央角膜厚度(CCT);根据每次随访时测得的眼压确定基线眼压及随访期间的眼压波动值(标准差)、平均眼压、最高眼压、最低眼压、眼压范围,视野缺损非进展组眼压数据截至最近一次随访,视野缺损进展组眼压数据截至进展当次随访.采用独立样本t检验、Mann-Whitney U检验及Cox比例风险模型进行统计学分析.结果 共纳入分析140例(140只眼)患者,其中男性67例,女性73例.19.3％(27/140)的患眼出现视野缺损进展,进展的中位时间为24.0(16.0,40.0)个月.视野缺损进展组、视野缺损非进展组眼轴长度分别为23.58(23.05,24.24)、23.91(23.10,24.91)mm(P=0.111),CCT分别为531.0(512.0,565.0)、535.0(518.5,552.0)μm(P=0.897),差异均无统计学意义;两组基线年龄分别为71.0(68.0,74.0)、68.0(58.0,72.0)岁(Z=-2.872,P=0.004),视野指数改变速率分别为-3.50(-7.10,-1.80)、0.40(-0.60,1.40)％/年(Z=-6.823,P<0.01),随访平均眼压分别为(16.2±2.7)、(15.1±2.4)mmHg(1 mmHg=0.133 kPa)(t=-2.215,P=0.028),随访眼压波动值分别为(2.6±1.3)、(2.0±0.7)mmHg(t=-2.175,P=0.038),差异均有统计学意义.多因素Cox比例风险模型显示基线年龄(HR=1.080;95％CI:1.019～1.143)、基线眼压(HR=1.120;95％CI:1.016～1.236)、随访平均眼压(HR=1.145;95％CI:1.001～1.309)及眼压波动值(HR=1.750;95％CI:1.193～2.566)越大,视野缺损进展风险越大;眼轴长度(HR=0.725;95％CI:0.532～0.988)越大,视野缺损进展风险越小.未发现CCT与视野缺损进展的关系(HR=1.000;95％CI:0.988～1.011).结论 温州地区POAG人群中基线年龄大、基线眼压高、随访平均眼压高及眼压波动值大、眼轴长度短为POAG视野缺损进展的危险因素.

abstractsObjective To evaluate risk factors for visual field (VF) loss progression in primary open-angle glaucoma patients. Methods A prospective nested case-control study. Patients were collected from the Wenzhou glaucoma progression study in the Eye Hospital of Wenzhou Medical University during March 2014 and April 2018. In this study, the eyes were divided into a progression group and a non-progression group using the glaucoma progression analysis methods to analyze the risk factors for glaucomatous VF loss progression. Axial length (AL) and central corneal thickness (CCT) were measured using the Lenstar LS900. The baseline, fluctuation (standard deviation), mean, maximum, minimum and&nbsp;range of intraocular pressure (IOP) during the follow-up period were determined based on IOP measured at each follow-up. The IOP measurements were included from the baseline to the last visit (for the non-progression group), or to the visit at which VF loss progression was determined (for the progression group). The independent sample t-test, Mann-Whitney U inspection and Cox proportional hazards models were used for statistical analysis. Results A total of 140 patients (140 eyes) were enrolled, including 67 males and 73 females. There were 19.3％of the eyes (27 of 140 eyes) showing VF loss progression. The median time to the endpoint for progression was 24.0 (16.0, 40.0) months. The AL in the progression group and non-progression group were 23.58 (23.05, 24.24) mm and 23.91 (23.10, 24.91) mm (P=0.111). The CCT in the two groups were 531.0 (512.0, 565.0)μm and 535.0 (518.5, 552.0)μm, respectively (P=0.897). The baseline age in the progression group and non-progression group was 71.0 (68.0, 74.0) years and 68.0 (58.0, 72.0) years, respectively (Z=-2.872, P=0.004). The slope of visual field index in the two groups was-3.50 (-7.10,-1.80)％/year and 0.40 (-0.60, 1.40)％/year, respectively (Z=-6.823, P<0.01). The mean IOP during the follow-up was (16.2 ± 2.7) mmHg (1 mmHg=0.133 kPa) in the progression group and (15.1 ± 2.4) mmHg in the non-progression group (t=-2.215, P=0.028). The IOP fluctuation in the progression group and non-progression group was (2.6±1.3) mmHg and (2.0±0.7) mmHg, respectively (t=-2.175, P=0.038). In the multivariate model, older baseline age (HR=1.080; 95％CI:1.019-1.143), higher baseline IOP (HR=1.120;95％CI:1.016-1.236), higher mean IOP (HR=1.145;95％CI:1.001-1.309) and higher IOP fluctuation (HR=1.750; 95％CI:1.193-2.566) were all significantly predictive risk factors for glaucomatous VF loss progression. Longer AL (HR=0.725; 95％CI: 0.532-0.988) was a protective factor against VF loss progression. However, CCT was found to be not associated with VF loss progression. Conclusion Baseline age, baseline IOP, mean IOP, IOP fluctuation and shorter AL are found to be risk factors for glaucomatous VF loss progression among eyes with primary open-angle glaucoma in Wenzhou.