玻璃体切割术治疗的中老年人非外伤性玻璃体积血病因分析

摘要

Objective To analyze the main causes of non-traumatic vitreous hemorrhage in middle-aged and elderly patients separately , and to comparatively analyze the different causes between middle-aged and elderly patients .Methods The causes of the initial diagno-sis of non-traumatic vitreous hemorrhage in 182 middle-aged and elderly patients(184 eyes)who underwent vitrectomy in The First Af-filiated Hospital of Anhui Medical University from January 2009 to June 2013 were retrospectively analyzed .Patients were assigned into two groups according to the age .Group A included 97 eyes of 97 patients from age 45 to 60 , while group B comprised 87 eyes of 85 pa-tients who were above age 60 .Two age groups of etiology were comparatively analyzed .Results Of all the patients , proliferative diabet-ic retinopathy (PDR) was the principal cause of non-traumatic vitreous hemorrhage( 80 eyes of 79 cases, 43.48%), followed by reti-nal vein occlusion (RVO) (79 eyes of 78 cases, 42.93%) and retinal hole or retinal detachment (RH/RD)(14 eyes of 14 cases, 7.61%).There was a total of 171 cases with 173 eyes, accounting for 94.02%of all patients with non-traumatic vitreous hemorrhage. There was statistical difference in the cause between group A and B (χ2 =17.589, P =0.001).In 97 eyes of group A, there were 34 eyes caused by retinal vein occlusion (RVO), 55 eyes caused by proliferative diabetic retinopathy (PDR), 6 eyes caused by retinal hole or retinal detachment (RH/RD) ,which accounted for 97.94% of the causes of group A.The proliferative diabetic retinopathy (PDR) was the principal cause (56.7%) in group A.In 87 eyes of group B, there were 45 eyes caused by retinal vein occlusion (RVO), 25 eyes caused by proliferative diabetic retinopathy (PDR) and 8 eyes caused by retinal hole or retinal detachment (RH/RD), 8 eyes caused by exudative age-related macular degeneration (EAMD), which accounted for 98.85%in group B.Patients with RVO comprised 51.72%in group B as the largest part .Conclusions The common causes of non traumatic vitreous hemorrhage in middle aged and elderly patients are RVO , PDR, RH/RD, and EAMD.Composition ratios are different in different age groups .PDR is commonly found among patients aged 45 to 60, while RVO is commonly found among patients above the age of 60.%目的：探讨中老年患者非外伤性玻璃体积血的主要病因，并对中年患者和老年患者病因进行对比分析。方法对2009年1月-2013年6月在该院首诊为非外伤性玻璃体积血并行玻璃体切割手术治疗的共182例（184只眼）的中老年患者玻璃体积血原因进行回顾性分析。按发病年龄对患者进行分组，45～60岁为中年组（ A组），≥60岁为老年组（ B组）， A组97例97只眼，B组85例87只眼，对比分析两个年龄段的病因构成。结果在所有患者中，玻璃体积血发生的最主要原因为增生型糖尿病视网膜病变（PDR），为79例80只眼，占43．48％；第二位为视网膜静脉阻塞（RVO）患者共78例79只眼，占42．93％，视网膜裂孔或孔源性视网膜脱离（ RH／RD）导致的玻璃体积血14例14只眼，占7．61％，是第三大原因。三者之和共171例173只眼，占所有非外伤性玻璃体积血患者的94．02％。 A组与B组之间的病因构成存在统计学差异（χ2＝17．589， P＝0．001）。 A组97只眼中，RVO 34只眼、PDR 55只眼、视网膜裂孔或脱离（RH／RD）6只眼、共占A组玻璃体积血患眼的97．94％；其中PDR患者比例最多占A组玻璃体积血患眼的56．70％。 B组87只眼中，RVO 45只眼、PDR 25只眼、RH／RD 8只眼、渗出性年龄相关性黄斑变性（EAMD）8只眼，共占B组玻璃体积血患眼的98．85％；其中RVO患者比例最多占B组玻璃体积血患眼的51．72％。结论玻璃体切割手术治疗的中老年人非外伤性玻璃体积血的常见原因为：RVO、PDR、RH／RD、EAMD；不同年龄段构成比不同，45～60岁人群中PDR多见；60岁以上人群中RVO多见。