Kang Jae H, Loomis Stephanie J, Rosner Bernard A, Wiggs Janey L, Pasquale Louis R
Channing Division of Network Medicine, Department of Medicine, Brigham & Women's Hospital, and Harvard Medical School, Boston, Massachusetts, United States.
Department of Ophthalmology, Massachusetts Eye and Ear, Boston, Massachusetts, United States.
Invest Ophthalmol Vis Sci. 2015 Apr;56(4):2439-48. doi: 10.1167/iovs.14-16088.
We explored whether risk factor associations differed by primary open-angle glaucoma (POAG) subtypes defined by visual field (VF) loss pattern (i.e., paracentral or peripheral).
We included 77,157 women in the Nurses' Health Study (NHS) and 42,773 men in the Health Professionals Follow-up Study (HPFS 1986-2010), and incident medical record confirmed cases of paracentral (n = 440) and peripheral (n = 865) POAG subtypes. We evaluated African heritage, glaucoma family history, body mass index (BMI), mean arterial blood pressure, diabetes mellitus, physical activity, smoking, caffeine intake, and alcohol intake. We used competing risk Cox regression analyses modeling age as the metameter and stratified by age, cohort, and event type. We sequentially identified factors with the least significant differences in associations with POAG subtypes ("stepwise down" approach with P for heterogeneity [P-het] < 0.10 as threshold).
Body mass index was more inversely associated with the POAG paracentral VF loss subtype than the peripheral VF loss subtype (per 10 kg/m2; hazard ratio [HR] = 0.67 [95% confidence interval (CI): 0.52, 0.86] versus HR = 0.93 [95% CI: 0.78, 1.10]; P-het = 0.03) as was smoking (per 10 pack-years; HR = 0.92 [95% CI: 0.87, 0.98] versus HR = 0.98 [95% CI: 0.94, 1.01]; P-het = 0.09). These findings were robust in sensitivity analyses using a "stepwise up" approach (identify factors that showed the most significant differences). Nonheterogeneous (P-het > 0.10) adverse associations with both POAG subtypes were observed with glaucoma family history, diabetes, African heritage, greater caffeine intake, and higher mean arterial pressure.
These data indicate that POAG with early paracentral VF loss has distinct as well as common determinants compared with POAG with peripheral VF loss.
我们探讨了根据视野（VF）损失模式（即中心旁或周边）定义的原发性开角型青光眼（POAG）亚型的危险因素关联是否存在差异。
我们纳入了护士健康研究（NHS）中的77157名女性和健康专业人员随访研究（HPFS，1986 - 2010年）中的42773名男性，以及经病历确诊的中心旁（n = 440）和周边（n = 865）POAG亚型病例。我们评估了非洲血统、青光眼家族史、体重指数（BMI）、平均动脉血压、糖尿病、身体活动、吸烟、咖啡因摄入量和酒精摄入量。我们使用竞争风险Cox回归分析，将年龄作为协变量进行建模，并按年龄、队列和事件类型进行分层。我们依次识别与POAG亚型关联差异最小的因素（采用“逐步下降”方法，以异质性P值[P-het]<0.10为阈值）。
体重指数与POAG中心旁VF损失亚型的负相关性比周边VF损失亚型更强（每10kg/m²；风险比[HR]=0.67[95%置信区间（CI）：0.52，0.86]，而HR = 0.93[95%CI：0.78，1.10]；P-het = 0.03），吸烟情况也是如此（每10包年；HR = 0.92[95%CI：0.87，0.98]，而HR = 0.98[95%CI：0.94，1.01]；P-het = 0.09）。在使用“逐步上升”方法（识别显示最显著差异的因素）的敏感性分析中，这些发现是稳健的。对于两种POAG亚型，青光眼家族史、糖尿病、非洲血统、更高的咖啡因摄入量和更高的平均动脉压均存在非异质性（P-het>0.10）的不良关联。
这些数据表明，与周边VF损失的POAG相比，早期中心旁VF损失的POAG具有不同的以及共同的决定因素。
