老年高血压患者视网膜病变发生状况及影响因素分析

doi:10.12183/j.scjpm.2023.1098

摘要/Abstract

摘要： 目的调查老年高血压患者视网膜病变发生状况,并探讨视网膜病变发生的影响因素。方法以2019年12月至2022年12月海南医学院第二附属医院、海南省老年病医院及海南西部中心医院诊治的高血压患者作为研究对象,对其进行眼部检查、基线资料调查和实验室指标检测,采用描述性分析方法对老年高血压患者视网膜病变发生状况进行分析,并采用单、多因素分析方法对老年高血压患者视网膜病变发生的影响因素进行分析。结果本研究共纳入772例老年高血压患者进行视网膜病变调查,共检出402例视网膜病变,检出率为52.07%,其中1级视网膜病变检出率为28.50%,2级为16.71%,3级为4.92%,4级为1.94%。多因素logistic回归分析显示年龄75~89岁（OR=2.196）、高血压病程>10年（OR=2.305）、血压控制不达标（OR=2.158）、糖尿病史（OR=1.520）、血脂异常史（OR=1.603）、尿酸>420 μmol/L（OR=1.583）、血管内皮生长因子（VEGF）>142 μmol/L（OR=2.458）、超敏C反应蛋白（hs‐CRP）>10 mg/L（OR=1.888）是老年高血压患者视网膜病变发生的危险因素。结论老年高血压患者视网膜病变发生率高,受到多种因素影响,建议临床可针对患者年龄、病程、血压控制情况、糖尿病、血脂异常、尿酸、VEGF、hs‐CRP等因素制定行之有效的干预措施,降低视网膜病变发生率。

关键词: 高血压, 老年人, 视网膜病变, 影响因素

Abstract: Objective To investigate the incidence of retinopathy in elderly patients with hypertension and explore its influencing factors. Methods The elderly patients with hypertension treated at the Second Affiliated Hospital of Hainan Medical University, Hainan Provincial Geriatric Hospital, and Hainan West Central Hospital from December 2019 to December 2022 were selected for the study. Eye examination, baseline data investigation, and laboratory index detection were performed on them, and the incidence of retinopathy in elderly patients with hypertension was analyzed by descriptive analysis method. The factors influencing the incidence of retinopathy in elderly patients with hypertension were analyzed by univariate and multivariate analysis methods. Results In this study, a total of 772 elderly patients with hypertension were included for retinopathy investigation, and a total of 402 cases of retinopathy were detected, with a detection rate of 52.07%, among which the detection rate of grade 1 retinopathy was 28.50%, grade 2 retinopathy was 16.71%, grade 3 retinopathy was 4.92%, and grade 4 retinopathy was 1.94%. Multivariate logistic regression analysis showed aged 75-89 years （OR=2.196）, duration of hypertension > 10 years （OR=2.305）, substandard blood pressure control （OR=2.158）, history of diabetes （OR=1.520）, history of dyslipidemia （OR=1.603）, uric acid > 420 μmol/L （OR=1.583）, vascular endothelial growth factor （VEGF）>142 μmol/L （OR=2.458）, hypersensitive C‐reactive protein （hs‐CRP）> 10 mg/L （OR=1.888） were the risk factors for retinopathy in elderly patients with hypertension. Conclusions The incidence of retinopathy in elderly patients with hypertension is high, which is affected by many factors. It is suggested that effective intervention measures can be developed according to the factors of age, disease course, blood pressure control, diabetes, dyslipidemia, uric acid, VEGF, hs‐CRP, etc., to reduce the incidence of retinopathy.

Key words: Hypertension, Elderly people, Retinopathy, Influencing factor

中图分类号:

R195

王石坚, 陈泽伦, 郑晶晶, 许瑛. 老年高血压患者视网膜病变发生状况及影响因素分析[J]. 华南预防医学, 2023, 49(9): 1098-1102.

WANG Shijian, CHEN Zelun, ZHENG Jingjing, XU Ying. Analysis of the incidence and influencing factors of retinopathy in elderly patients with hypertension[J]. South China Journal of Preventive Medicine, 2023, 49(9): 1098-1102.

参考文献

[1] Kućmierz J,Frąk W,Młynarska E,et al.Molecular interactions of arterial hypertension in its target organs[J].Int J Mol Sci,2021,22(18):9669.
[2] 栗映梅,吴欣怡,王玉,等.宁阳县城乡居民高血压患者视网膜病变现况分析[J].山东大学学报(医学版),2013,51(1):98-102.
[3] 李建军,王爽,刘雪,等.高血压性视网膜病变远程筛查与诊断分级标准(征求意见稿)[J].眼科,2015,24(5):294-295.
[4] 中华医学会,中华医学杂志社,中华医学会全科医学分会,等.高血压基层诊疗指南(2019年)[J].中华全科医师杂志,2019,18(4):301-313.
[5] 陈春明,孔灵芝.中国成人超重和肥胖症预防控制指南[M].北京:人民卫生出版社,2006:1-35.
[6] 《中国高血压基层管理指南》修订委员会.中国高血压基层管理指南(2014 年修订版)[J].中华高血压杂志,2015,23(1):24-43.
[7] 中华医学会糖尿病学分会.中国2型糖尿病防治指南(2017年版)[J].中国实用内科杂志,2018,38(4):292-344.
[8] 中华医学会.血脂异常基层诊疗指南(实践版·2019)[J].中华全科医师杂志,2019,18(5):417-421.
[9] 葛均波,徐永健,王辰.内科学.[M].9版.北京:人民卫生出版社,2018:219-234.
[10] 杨培增,范先群.眼科学[M].9版.北京:人民卫生出版社,2018:195.
[11] Aissopou EK,Papathanassiou M,Nasothimiou EG,et al.The Keith-Wagener-Barker and Mitchell-Wong grading systems for hypertensive retinopathy: Association with target organ damage in individuals below 55 years[J].J Hypertens,2015,33(11):2303-2309.
[12] 姚溪,裴晓婷,曲哲.1991—2015年中国成人高血压患病率,知晓率,治疗率,控制率的变化趋势及其影响因素研究[J].中国全科医学,2022,25(7):803-814.
[13] Nam KY,Lee MW,Jun JH,et al.Different characteristics of retinal damage between chronic hypertension and hypertensive retinopathy[J].Sci Rep,2022,12(1):18902.
[14] Zhang YP,Wang YX,Zhou JQ,et al.The Influence of diabetes, hypertension, and hyperlipidemia on the onset of age-related macular degeneration in North China: The Kailuan Eye Study[J].Biomed Environ Sci,2022,35(7):613-621.
[15] Zhang Y,Zhao L,Li H,et al.Risk factors for hypertensive retinopathy in a Chinese population with hypertension: The Beijing Eye Study[J].Exp Ther Med,2019,17(1):453-458.
[16] White NH,Pan Q,Knowler WC,et al.Risk factors for the development of retinopathy in prediabetes and type 2 diabetes: The diabetes prevention program experience[J].Diabetes Care,2022,45(11):2653-2661.
[17] 程璐瑶,郭海健,孙凯成,等.江苏省城乡居民不同糖代谢状态人群视网膜病变患病率及相关因素分析[J].中华糖尿病杂志,2021,13(3):245-251.
[18] Bryl A,Mrugacz M,Falkowski M,et al.The effect of hyperlipidemia on the course of diabetic retinopathy-literature review[J].J Clin Med,2022,11(10):2761.
[19] Fu Z,Chen CT,Cagnone G,et al.Dyslipidemia in retinal metabolic disorders[J]. EMBO Mol Med,2019,11(10):e10473.
[20] 陈斌,齐晓玲,徐礼五,等.β2-MG、Hcy、Cys-C检测在2型糖尿病视网膜病变诊断中的价值[J].分子诊断与治疗杂志,2020,12(6):818-821,826.
[21] Chen D,Sun X,Zhao X,et al.Associations of serum uric acid and urinary albumin with the severity of diabetic retinopathy in individuals with type 2 diabetes[J]. BMC Ophthalmol,2020,20(1):467.
[22] 牛晓歌,张丁丁,张云,等.高血压患者尿酸,总胆固醇与动态动脉硬化指数的关系[J].中国动脉硬化杂志,2018,26(7):711-714.
[23] 王秀秀,尹慧,王雅琼.血清脂联素及尿酸水平与2型糖尿病视网膜病变的相关性研究[J].中华内分泌外科杂志,2020,14(3):228-232.
[24] 苏倍倍,应长江,张艺凡,等.血尿酸/高密度脂蛋白胆固醇比值与2型糖尿病视网膜病变的相关性研究[J].中国糖尿病杂志,2022,30(4):266-271.
[25] 陈彦,潘建,骆亦婷,等.高血压患者视网膜病变与血清血管内皮生长因子及Toll样受体4的相关性[J].中华高血压杂志,2022,30(4):387-390.
[26] Lee SS,Beales DJ,Chen FK,et al.Associations between seven-year C-reactive protein trajectory or pack-years smoked with choroidal or retinal thicknesses in young adults[J].Sci Rep,2021,11(1):6147.
[27] 赵培培,蒋玲,李科.高血压患者自我健康管理现状及影响因素研究[J].华南预防医学,2023,49(1):10-13.