周边视网膜神经纤维层厚度的性别特异性差异。
Sex-Specific Differences in Circumpapillary Retinal Nerve Fiber Layer Thickness.
机构信息
Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany; Schepens Eye Research Institute, Harvard Medical School, Boston, Massachusetts.
Leipzig Research Centre for Civilization Diseases, Leipzig University, Leipzig, Germany; Institute for Medical Informatics, Statistics, and Epidemiology, Leipzig University, Leipzig, Germany.
出版信息
Ophthalmology. 2020 Mar;127(3):357-368. doi: 10.1016/j.ophtha.2019.09.019. Epub 2019 Sep 25.
PURPOSE
To investigate the role of sex on retinal nerve fiber layer (RNFL) thickness at 768 circumpapillary locations based on OCT findings.
DESIGN
Population-based cross-sectional study.
PARTICIPANTS
We investigated 5646 eyes of 5646 healthy participants from the Leipzig Research Centre for Civilization Diseases (LIFE)-Adult Study of a predominantly white population.
METHODS
All participants underwent standardized systemic assessments and ocular imaging. Circumpapillary RNFL (cRNFL) thickness was measured at 768 points equidistant from the optic nerve head using spectral-domain OCT (Spectralis; Heidelberg Engineering, Heidelberg, Germany). To control ocular magnification effects, the true scanning radius was estimated by scanning focus. Student t test was used to evaluate sex differences in cRNFL thickness globally and at each of the 768 locations. Multivariable linear regression and analysis of variance were used to evaluate individual contributions of various factors to cRNFL thickness variance.
MAIN OUTCOME MEASURES
Difference in cRNFL thickness between males and females.
RESULTS
Our population consisted of 54.8% females. The global cRNFL thickness was 1 μm thicker in females (P < 0.001). However, detailed analysis at each of the 768 locations revealed substantial location specificity of the sex effects, with RNFL thickness difference ranging from -9.98 to +8.00 μm. Females showed significantly thicker RNFLs in the temporal, superotemporal, nasal, inferonasal, and inferotemporal regions (43.6% of 768 locations), whereas males showed significantly thicker RNFLs in the superior region (13.2%). The results were similar after adjusting for age, body height, and scanning radius. The superotemporal and inferotemporal RNFL peaks shifted temporally in females by 2.4° and 1.9°, respectively. On regions with significant sex effects, sex explained more RNFL thickness variance than age, whereas the major peak locations and interpeak angle explained most of the RNFL thickness variance unexplained by sex.
CONCLUSIONS
Substantial sex effects on cRNFL thickness were found at 56.8% of all 768 circumpapillary locations, with specific patterns for different sectors. Over large regions, sex was at least as important in explaining the cRNFL thickness variance as was age, which is well established to have a substantial impact on cRNFL thickness. Including sex in the cRNFL thickness norm could therefore improve glaucoma diagnosis and monitoring.
目的
基于 OCT 检查结果，研究性别对 768 个圆周神经纤维层（RNFL）厚度的影响。
设计
基于人群的横断面研究。
参与者
我们调查了莱比锡文明病研究中心（LIFE）成人研究中一个以白种人为主的 5646 名健康参与者的 5646 只眼。
方法
所有参与者均接受了标准化的全身评估和眼部成像。使用频域光学相干断层扫描（Spectralis；海德堡工程公司，海德堡，德国）在距视神经头等距的 768 个点测量圆周 RNFL（cRNFL）厚度。为了控制眼放大效应，通过扫描焦点估计真实扫描半径。使用学生 t 检验评估 cRNFL 厚度在全球和 768 个位置的性别差异。多元线性回归和方差分析用于评估各种因素对 cRNFL 厚度方差的个体贡献。
主要观察指标
男性和女性之间 cRNFL 厚度的差异。
结果
我们的人群中女性占 54.8%。女性的全球 cRNFL 厚度厚 1μm（P<0.001）。然而，在 768 个位置的每个位置的详细分析都显示出性别影响的位置特异性，RNFL 厚度差异范围从-9.98μm 到+8.00μm。女性在颞、上颞、鼻侧、鼻下和颞下区域的 RNFL 明显更厚（768 个位置的 43.6%），而男性在上方区域的 RNFL 明显更厚（13.2%）。调整年龄、身高和扫描半径后，结果相似。女性的上颞和颞下 RNFL 峰分别向颞侧移动 2.4°和 1.9°。在具有显著性别效应的区域，性别比年龄能更好地解释 RNFL 厚度的差异，而主要的峰位置和峰间角度则能很好地解释性别无法解释的大部分 RNFL 厚度差异。
结论
在 768 个圆周神经纤维层厚度的 56.8%位置发现了明显的性别对 cRNFL 厚度的影响，不同区域存在特定的模式。在较大的区域中，性别在解释 cRNFL 厚度方差方面至少与年龄一样重要，而年龄对 cRNFL 厚度有很大影响，这一点已得到充分证实。因此，将性别纳入 cRNFL 厚度正常范围可以改善青光眼的诊断和监测。
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