经筛板的压力差与开角型青光眼。中央印度眼与医学研究。
Trans-lamina cribrosa pressure difference and open-angle glaucoma. The central India eye and medical study.
机构信息
Suraj Eye Institute, Nagpur, India ; Department of Ophthalmology, Medical Faculty Mannheim of the Ruprecht-Karls-University of Heidelberg, Mannheim, Germany.
出版信息
PLoS One. 2013 Dec 6;8(12):e82284. doi: 10.1371/journal.pone.0082284. eCollection 2013.
PURPOSE
To assess associations of the trans-lamina cribrosa pressure difference (TLCPD) with glaucomatous optic neuropathy.
METHODS
The population-based Central India Eye and Medical Study included 4711 subjects. Based on a previous study with lumbar cerebrospinal fluid pressure (CSFP) measurements, CSFP was calculated as CSFP[mmHg] = 0.44 Body Mass Index[kg/m2]+0.16 Diastolic Blood Pressure[mmHg]-0.18×Age[Years] -1.91. TLCPD was IOP-CSFP.
RESULTS
Mean TLCPD was 3.64±4.25 mm Hg in the non-glaucomatous population and 9.65±8.17 mmHg in the glaucomatous group. In multivariate analysis, TLCPD was associated with older age (P<0.001; standardized coefficient beta:0.53; regression coefficient B:0.18; 95% confidence interval (CI):0.17, 0.18), lower body mass index (P<0.001; beta: -0.28; B: -0.36; 95%CI: -0.38, -0.31), lower diastolic blood pressure (P<0.001; beta: -0.31; B: -0.12; 95%CI: -0.13, -0.11), higher pulse (P<0.001; beta:0.05; B:0.02; 95%CI:0.01,0.2), lower body height (P = 0.02; beta: -0.02; B: -0.01; 95%CI: -0.02,0.00), higher educational level (P<0.001; beta:0.04; B:0.15; 95%CI:0.09,0.22), higher cholesterol blood concentrations (P<0.001; beta:0.04; B:0.01; 95%CI:0.01,0.01), longer axial length (P = 0.006; beta:0.03; B:0.14; 95%CI:0.04,0.24), thicker central cornea (P<0.001; beta:0.15; B:0.02; 95%CI:0.02,0.02), higher corneal refractive power (P<0.001; beta:0.07; B:0.18; 95%CI:0.13,0.23) and presence of glaucomatous optic neuropathy (P<0.001; beta:0.11; B:3.43; 95%CI:2.96,3.99). Differences between glaucomatous subjects and non-glaucomatous subjects in CSFP were more pronounced for open-angle glaucoma (OAG) than for angle-closure glaucoma (ACG) (3.0 mmHg versus 1.8 mmHg), while differences between glaucomatous subjects and non-glaucomatous subjects in IOP were higher for ACG than for OAG (8.5 mmHg versus 3.0 mmHg). Presence of OAG was significantly associated with TLCPD (P<0.001; OR:1.24; 95%CI:1.19,1.29) but not with IOP (P = 0.08; OR:0.96; 95%CI:0.91,1.00). Prevalence of ACG was significantly associated with IOP (P = 0.04; OR:1.19; 95%CI:1.01,1.40) but not with TLCPD (P = 0.92).
CONCLUSIONS
In OAG, but not in ACG, calculated TLCPD versus IOP showed a better association with glaucoma presence and amount of glaucomatous optic neuropathy. It supports the notion of a potential role of low CSFP in the pathogenesis of open-angle glaucoma.
目的
评估跨脊筛板压力差（TLCPD）与青光眼视神经病变的相关性。
方法
本研究基于中央印度眼与医学研究的人群基础，共纳入 4711 名受试者。根据之前的腰椎脑脊液压力（CSFP）测量研究，CSFP 计算为 CSFP[mmHg] = 0.44 体重指数[kg/m2] + 0.16 舒张压[mmHg] - 0.18×年龄[岁] - 1.91。TLCPD 为 IOP-CSFP。
结果
在非青光眼人群中，平均 TLCPD 为 3.64±4.25mmHg，而在青光眼组中为 9.65±8.17mmHg。在多变量分析中，TLCPD 与年龄较大（P<0.001；标准化系数β：0.53；回归系数 B：0.18；95%置信区间（CI）：0.17，0.18）、较低的体重指数（P<0.001；β：-0.28；B：-0.36；95%CI：-0.38，-0.31）、较低的舒张压（P<0.001；β：-0.31；B：-0.12；95%CI：-0.13，-0.11）、较高的脉搏（P<0.001；β：0.05；B：0.02；95%CI：0.01，0.2）、较低的身高（P=0.02；β：-0.02；B：-0.01；95%CI：-0.02，0.00）、较高的教育水平（P<0.001；β：0.04；B：0.15；95%CI：0.09，0.22）、较高的胆固醇血浓度（P<0.001；β：0.04；B：0.01；95%CI：0.01，0.01）、较长的眼轴长度（P=0.006；β：0.03；B：0.14；95%CI：0.04，0.24）、较厚的中央角膜（P<0.001；β：0.15；B：0.02；95%CI：0.02，0.02）、较高的角膜屈光力（P<0.001；β：0.07；B：0.18；95%CI：0.13，0.23）和青光眼视神经病变的存在（P<0.001；β：0.11；B：3.43；95%CI：2.96，3.99）有关。与非青光眼受试者相比，开角型青光眼（OAG）患者的 CSFP 差异比闭角型青光眼（ACG）更为明显（3.0mmHg 比 1.8mmHg），而与非青光眼受试者相比，ACG 患者的 IOP 差异比 OAG 更为明显（8.5mmHg 比 3.0mmHg）。OAG 的存在与 TLCPD 显著相关（P<0.001；OR：1.24；95%CI：1.19，1.29），但与 IOP 无关（P=0.08；OR：0.96；95%CI：0.91，1.00）。ACG 的患病率与 IOP 显著相关（P=0.04；OR：1.19；95%CI：1.01，1.40），但与 TLCPD 无关（P=0.92）。
结论
在 OAG 中，而不是在 ACG 中，计算的 TLCPD 与 IOP 与青光眼的存在和青光眼视神经病变的严重程度有更好的相关性。这支持了低 CSFP 在开角型青光眼发病机制中的潜在作用的观点。
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