外周血脂质水平与原发性开角型青光眼的关联研究

摘要

目的 探讨外周血脂质水平与原发性开角型青光眼(POAG)及其眼压的相关性.方法 采用回顾性病例对照研究设计,收集2015年1月至2016年5月于复旦大学附属眼耳鼻喉科医院确诊为POAG的80例患者作为POAG病例组,同时收集与病例组年龄、性别相匹配的80名健康体检者作为对照组.男性组(POAG组:44例,对照组:39例)和女性组(POAG组:36例,对照组:41例)的年龄差异均无统计学意义(t=-0.320,P=0.750;t=-0.589,P=0.557).运用全自动生化分析仪,测定血清总胆固醇(TC)、总甘油三酯(TG)、高密度脂蛋白胆固醇(HDL-C)、低密度脂蛋白胆固醇(LDL-C)、载脂蛋白A(Apo A)和载脂蛋白B(Apo B)水平.采用独立样本t检验及多因素logistic回归,分析上述脂质浓度在POAG组和对照组间的差异及其与POAG的相关性;采用Pearson相关性检验进一步分析血脂水平与POAG眼压之间的关系.结果 TG水平在POAG组为(1.40±0.71)mmol/L,对照组为(1.00±0.37)mmol/L,两组间差异有统计学意义(t=4.467,P<0.001);HDL-C水平在POAG组中为(1.22±0.36)mmol/L,对照组为(1.38±0.25)mmol/L,两组间差异也有统计学意义(t=-3.228,P=0.002).男性和女性亚组分析发现男性TG水平在POAG组中为(1.47±0.71)mmol/L,对照组为(1.01±0.36)mmol/L,HDL-C水平分别为(1.14±0.31)mmol/L,(1.32±0.20)mmol/L,两项指标在POAG组和对照组间差异均有统计学意义(t=3.717,P<0.001;t=-3.240,P=0.002).女性TC水平在POAG组中为(4.59±0.81)mmol/L,对照组为(4.21±0.64)mmol/L,TG水平分别为(1.33±0.72)mmol/L,(0.99±0.38)mmol/L,两项指标在POAG组中均显著高于对照组(t=2.278,P=0.026;t=2.503,P=0.016).Logistic回归分析显示TG水平与POAG发病存在明显相关性 (P=0.004,OR=2.831,95% CI=1.392~5.759),与男性和女性的POAG发病也存在相关性(P=0.025,OR=3.223,95% CI=1.156~8.989;P=0.045,OR=2.554,95% CI=1.020~6.395).Pearson相关分析发现无论是否按性别分组,POAG患者血清TG水平均与眼压呈显著正相关(P<0.05).结论 POAG患者外周血TG水平显著升高并与眼压呈正相关,提示外周血TG水平升高是POAG的独立危险因素.%Objective To explore the relationship between blood lipid level and primary open angle glaucoma(POAG)and intraocular pressure(IOP).Methods A retrospective case-control study was designed.80 POAG patients from EYE & ENT hospital of FUDAN university were collected as a case group from January 2015 to May 2016.Meanwhile 80 age and gender matched healthy people were collected as a control group.The differences of gender in men subgroup (POAG:44,Control:39) and female subgroup (POAG:36,Control:41) showed no statistic significance.Serum total cholesterol(TC),total triglyceride(TG),high density lipoprotein cholesterol(HDL-C),low density lipoprotein cholesterol(LDL-C),apolipoprotein A(Apo A) and apolipoprotein B(Apo B) were measured using Roche automatic biochemical analyzer.The analysis of the above mentioned lipid levels between POAG group and control group was conducted by independent student′s T test and multivariate logistic regression.The relationship between lipid level and IOP was analysied using Pearson correlation test.Results The TG level was (1.40±0.71)mmol/L in the POAG group,(1.00±0.37)mmol/L in the control group.The difference had statistic significance (t=4.467,P<0.001).The HDL-C level in the POAG group was (1.22±0.36)mmol/L,(1.38±0.25)mmol/L in the control group.The difference also had statistic significance (t=-3.228,P=0.002).Comparison between the men subgroup and female subgroup found that the TG level in the POAG group of men was (1.47±0.71)mmol/L,(1.01±0.36) mmol/L in the control group and the HDL-C level were (1.14±0.31) mmol/L,(1.32±0.20)mmol/L in two groups.Both the level of TG and HDL-C had statistic significance in men (t=3.717,P<0.001;t=-3.240,P=0.002).The TC,TG level in the POAG group and control group of women respectively were (4.59±0.81)mmol/L,(1.33±0.72)mmol/L and (4.21±0.64)mmol/L,(0.99±0.38)mmol/L.Both blood level were significantly higher than the control group in women (t=2.278,P=0.026;t=2.503,P=0.016).Logistic regression analysis showed that the TG level correlated with POAG (P=0.004,OR=2.831,95% CI=1.392-5.759)and both POAG in the men and women (P=0.025,OR=3.223,95% CI=1.156-8.989;P=0.045,OR=2.554,95% CI=1.020-6.395).Pearson test showed that the TG level of POAG patients was positively associated with IOP in spite of gender(P<0.05).Conclusion The peripheral blood level of TG was significantly increased in the POAG patients and significantly correlated with IOP,which indicated that the increased peripheral blood level of TG may be the independent risk factor for the POAG..