摘要
目的利用Meta分析法研究1980年至今我国人群青光眼的流行病学特征。方法检索Pubmed、ScienceDirect、中国知网及万方数据等数据库,检索自1980年至今。搜集青光眼、原发性青光眼、原发性闭角型青光眼(PACG)及原发性开角型青光眼(POAG)的流行病学研究。由两位研究员独立筛选文献并提取患病率、致盲率以及青光眼致盲在不可逆盲的占比,并进行合并。1990年的合并结果依据1980年至1990年期间开展的研究,依此类推直至2020年。文献研究间的异质性评价,采用Q检验和I^(2)检验。如P<0.05或I^(2)>50%则认为异质性较大,采用随机效应模型分析;反之,采用固定效应模型。采用Meta分析中描述性统计分析描述流行特征的趋势。结果初步获取文献4440篇。经过文献查重、快速初筛及文献全文阅读,最终纳入文献60篇,共计观察4581057人,覆盖中国23个省份及直辖市。其中,青光眼患病率与致盲率文献26篇,覆盖中国19个省份及直辖市;青光眼致盲在不可逆盲占比的文献34篇,覆盖中国17个省份及直辖市。1990年中国人群青光眼与原发性青光眼的患病率分别为0.5%(95%CI:0.5%~0.6%,I^(2)=7%,P>0.05)与0.5%(95%CI:0.4%~0.6%,I^(2)=7%,P>0.05)。此后,均逐年升高。至2020年青光眼与原发性青光眼患病率分别为2.5%(95%CI:2.2%~2.8%,I^(2)=85%,P<0.05)与2.2%(95%CI:1.6%~2.5%,I^(2)=89%,P>0.05)较2010年下降;PACG患病率从1990年的0.4%升高至2010年的1.7%后下降至2020年的1.1%;而POAG的患病率则逐年增加,由1990年的0.1%逐渐升高至2010年的0.3%,并在2020年显著升高至1.1%。自1990年起,PACG占所有类型青光眼患者的比例逐年下降,由80%下降至2020年的43.8%;而POAG患者占所有类型青光眼患者的比例逐年上升,由1990年的20%升高至43.8%;其他类型青光眼包括继发性青光眼等也逐年上升,由1990年的2%升高至2020年的12.4%。青光眼致盲率自1990年的24.4%(95%CI:16.7%~34.4%,I^(2)=0%,P>0.05)升高至2000年31.7%(95%CI:24.5%~39.8%,I^(2)=0%,P>0.05)后逐年下降至2020年的24.1%(95%CI:19.9%~29.2%,I^(2)=58%,P>0.05)。PACG致盲率由1990年36.8%升高至2000年63.1%,于2010年下降至26.2%直至2020年的25.7%,并保持平稳。POAG致盲率近40年的流行态势相对平稳,介于12.4%~17.4%间。此外,青光眼致盲占所有不可逆盲的比例下降。由1990年的59.6%逐年下降,最大降幅达62.2%。结论在人口老龄化和青光眼筛查诊断技术提高的背景下,我国青光眼患病率较前提升。PACG患病率的下降与白内障手术技术普及可能相关,在PACG诊断治疗适宜技术和诊断治疗方案和指南的推广应用下,致盲率较前降低。近年来,POAG患病率较高与青光眼筛查技术提高普及相关,未来针对POAG诊断与治疗技术的研究和推广任务仍艰巨。
Objective To obtain the prevalence of glaucoma and its characteristics in China:a meta analysis from 1980 to the present.Methods The epidemiological studies on glaucoma in community populations in China from 1980 to 2020 were reviewed and a meta-analysis was carried out.Pubmed ScienceDirect,Wan Fang database and CNKI database were searched using glaucoma,primary glaucoma,primary open-angle glaucoma(POAG),and primary angle-closure glaucoma(PACG).Two researchers independently screened the literatures and extracted the prevalence,blinding rate(BR),and proportion of blindness caused by glaucoma in irreversible blindness cases(GB ratio),and then were calculated.The data of 1990 was the summary of studies published in 1980 to 1990,and so on until 2020.The inter-study heterogeneity evaluation was conducted with theQtest andI^(2)test.IfP<0.05 orI^(2)>50%,the heterogeneity is considered large,and the random effect model was used;otherwise,the fixed effect model would be used.The characteristics of the abovementioned parameters was represented by a descriptive statistical analysis.Results After preliminary search,4440 publications were obtained and then the deduplication,non-related abstract and full-text were excluded.Finally,60 publications on studies carried out in 23 provinces and municipalities were included,including 26 studies carried out in19 provinces and municipalities on the prevalence and BR,and 34 studies carried out in 17 provinces and municipalities on the GB ratio.In 1990,the prevalence of glaucoma and primary glaucoma was 0.5%(95%CI:0.5%to 0.6%,I^(2)=7%,P>0.05)and 0.5%(95%CI:0.4%to 0.6%,I^(2)=7%,P>0.05),which has been increasing ever since.In 2020,the prevalence of glaucoma and primary glaucoma dropped compared with that in 2010 and was 2.5%(95%CI:2.2%to 2.8%,I^(2)=85%,P<0.05)and 2.2%(95%CI:1.6%to 2.5%,I^(2)=89%,P>0.05).The prevalence of PACG increased from 0.4%in 1990 increased to 1.7%in 2010 and then decreased to 1.1%in 2020,while the prevalence of POAG has increased year by year,from 0.1%in 1990 to 0.3%in 2010,followed by a significant increase to 1.1%in 2020.Since 1990,the proportion of PACG cases in all glaucoma cases has decreased year by year,from 80%to 43.8%in 2020,while the proportion of POAG cases has increased annually,from 20%in 1990 to 43.8%,and the proportion of other types of glaucoma has also increased annually from 2%in 2010 to 12.4%in 2020.BR increased from 24.4%(95%CI:16.7%to 34.4%,I^(2)=0%,P>0.05)in 1990 to 31.7%in 2000(95%CI:24.5%to 39.8%,I^(2)=0%,P>0.05)and then decreased to 24.1%in 2020(95%CI:19.9%to 29.2%,I^(2)=58%,P>0.05).BR of PACG increased from 36.8%in 1990 to 63.1%in 2000 and then decreased to 26.2%in 2010 and 25.7%in 2020,with a steady development.BR of POAG remained relatively stable in the past 4 decades,ranging from 12.4%to 17.4%.In addition,GB ratio has a biggest decline of 62.2%,from 59.6%in 1990 to 2020.Conclusions Population ageing and the advancement of glaucoma screening and diagnosis have contributed to the increase in the prevalence of glaucoma in China.The decline in the prevalence of PACG is closely related to the popularization of cataract surgery techniques.With the nationwide promotion of the prevention and treatment system based on etiological classification and precise diagnosis and treatment,BR of PACG has significantly reduced.The high prevalence of POAG in recent years may be a result of the improvement in and popularization of glaucoma screening techniques.In future,more efforts should be made to research and promote POAG diagnosis and treatment techniques.
作者
金杉杉
熊琨
王璐
梁远波
Jin Shanshan;Xiong Kun;Wang Lu;Liang Yuanbo(Beijing Tongren Eye Center,Beijing Tongren Hospital,Capital Medical University,Beijing Institute of Ophthalmology,Beijing Key Laboratory of Institute of Ophthalmology and Visual Sciences,Beijing 100730,China;The Clinical Research Center of Glaucoma,The Eye Hospital,School of Ophthalmology and Optometry,Wenzhou Medical University,The Institute of Glaucoma of Wenzhou Medical University,National Clinical Research Center for Ocular Diseases,Wenzhou 325027,China;National Center for AIDS/STD Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 102206,China)
出处
《中华眼科医学杂志（电子版）》
2022年第6期332-340,共9页
Chinese Journal of Ophthalmologic Medicine(Electronic Edition)
基金
国家重点研发计划项目(2020YFC2008204)
