上海市北新泾街道老年人高度近视眼的流行病学调查

Objective To investigate the prevalence of high myopia,the prevalence and risk factors of high myopia associated with chorioretinopathy in residents aged 60 years or over in Beixinjing community, Shanghai, China. Methods A cluster stratified random sampling method was used to screen 4153 people aged 60 and over in Beixinjing community. There were 3851participants in total with a 92.73% response rate. Participants were invited to complete a questionnaire and received a comprehensive eye examination including visual acuity, refraction, slit-lamp microscopic examination, direct ophthalmoscopy and fundus photography and so on. Spherical equivalent (SE) was used to determine the degree of refractive errors. The diagnosis of high myopic chorioretinopathy was made if SE>-6.00 D and myopic ehorioretinal atrophy lesions were presented such as posterior seleral staphyloma, lacquer cracks, Fuchs spot and myopic arc spots. The degree of visual acuity impairment was determined according to the World Health Organization (WHO) classification as low vision (the best corrected visual acuity≥0. 05, but <0.3) or blindness (the best corrected visual acuity < 0. 05). Results There were 207/3851 (5.37 %) high myopia patients, in which 183/207 (88.40%) patients were associated with myopic chorioretinopathy. The prevalence of myopic chorioretinopathy decreased while age increased (X2= 19.21, P<0.01), but statistically there was no gender difference (X2= 1.83, P>0.05). Logistic regression analysis showed that there were significant differences in the prevalence of high myopia between people with different age, educational levels and family history (X2= 19.21,32. 08,960. 68; P<0.01). There were 29 cases of bilateral blindness, 96 cases of unilateral blindness, 104 cases of bilateral low vision and 562 cases of unilateral low vision in those participants. In 183 cases of high myopic chorioretinopathy patients, 111(60.65 %)cases had an obvious visual impairment, including 34.48% (10 cases) of bilateral blindness, 11.46% (11 cases) of unilateral blindness, 29.81% (31 cases)of bilateral low vision and 10.50% (59 cases) of unilateral low vision. Conclusions The prevalence of high myopia of residents aged ≥ 60 years in Beixinjing community, Shanghai, China is relatively high. Age, education level and family history are the most important factors affecting the occurrence of chorioretinopathy in high myopia patients.     

上海市北新泾糖尿病视网膜病变社区远程筛查与传统筛查系统的成本比较

从2003年起，本课题组将远程医学运用于社区眼病防治领域，建立了上海市北新泾糖尿病视网膜病变（DR）社区远程筛查系统，即由经培训的基层卫生工作者在社区医疗单位完成视力检查和数码眼底照相，经互联网将数据发送到三级医院，有经验的眼科专家读片诊断，并发送回社区。具体技术和可信度研究等已另文报道。它与我国居民目前普遍采用的到三级医院就诊，由专科医生采用眼底镜和非接触镜诊断筛查DR的传统模式相比，该远程筛查模式是否更加经济，是其广泛推广的关键。本文简单总结了采用卫生经济学方法对两种筛查模式所需成本的比较结果。     

上海市北新泾街道60岁及以上人群盲和视力损伤的现况调查

Objective To investigate the prevalence rate of blindness and low vision and the leading cause of blindness in residents aged ≥60 years in Beixinjing blocks, Shanghai. Methods A cross-sectional study was carried out by Shanghai First People's Hospital, affiliated Shanghai Jiaotong University and Shanghai Beixinjing Community hospital from November 2007 to April 2008. Randomly cluster sampling method was used ,and all the individuals aged ≥60 years in 8 communities from Beixinjing blocks, Shanghai was enrolled in this study. The pinhole visual acuity and presenting visual acuity were measured separately in each eye. External eye, anterior segment and ocular fundus were examined by the ophthalmologist using slit lamp-microscopes, direct ophthalmoscopy and non-mydriatic digital camara. Assigned ophthalmolngic doctors assured the leading blind causes of every blind person. The survey was preceded by a pilot study where operational methods were refined and quality assurance evaluation was carried out. Results 3851 individuals were examined, and the response rate was 92. 73%. According to WHO diagnostic criteria: 29 persons were diagnosed as blindness, 11 male (37.93%) and 18 female (62.07%). 104 persons were diagnosed as low vision, 37 male (35. 58% ) and 67 female (64. 42% ) . The prevalence rates of blindness and low vision were 0. 75% and 2. 70%. The leading causes of blindness were macular degeneration, cataract, corneal diseases, and retinal detachment According to presenting vision diagnostic criteria: 61 persons were diagnosed as severe binocular blindness, 20 male (32. 79% ) and 41 female (67. 21% ) . 66 persons were diagnosed as slight binocular blindness, 27 male (40. 91% ) and 39 female (59. 09% ) . 276 persons were diagnosed as monocular blindness, 120 male (43.48%) and 156 female (56. 52% ). The prevalence of severe binocular blindness, slight binocular blindness and monocular blindness was 1.58% , 1.71% and 7. 17%, respectively. The leading causes of blindness were macular degeneration, cataract, ametropia and corneal diseases. Conclusion The leading cause of blindness was macular degeneration. The prevalence of degenerative retinopathy in this area is on the rise.     

上海市北新泾街道60岁及以上人群盲和视力损伤的现况调查

目的 调查上海市北新泾街道60岁及以上老年人低视力、盲的患病率及致盲原因,并与以前调查结果相比较,评价近年该地区实施防盲治盲项目的 效果.方法 应用横断面研究的流行病学调查方法.由上海交通大学附属第一人民医院和上海市长宁区北新泾社区卫生服务中心于2007年11月至2008年4月采用整群随机抽样方法在上海市长宁区北新泾街道抽取8个社区,对其中所有的60岁及以上老年人进行调查,检查日常生活视力和针孔镜矫正视力,应用裂隙灯显微镜、直接检眼镜和眼底照相机等仪器检查受检者外眼、眼前节及眼底等情况.观察低视力及盲的患病情况,分析致盲的主要原因.正式调查前先进行预试验,通过计算kappa值进行不同检查者诊断结果的重复性检验,保证调查质量.结果 在应检录4153人中,受检人数为3851人,受检率为92.73%.按照世界卫生组织视力损伤标准:双眼盲29人,其中男性11人(占37.93%)、女性18人(占62.07%).双眼低视力104人,其中男性37人(占35.58%)、女性67人(占64.42%).双眼盲和双眼低视力的患病率分别为0.75%和2.70%.致盲的主要原因依次为:黄斑变性、白内障、角膜瘢痕或混浊及视网膜脱离.按照日常生活视力和视力损伤标准:重度双眼盲61人,其中男性20人(占32.79%)、女性41人(占67.21%).轻度双眼盲66人,其中男性27人(占40.91%)、女性39人(占59.09%).单眼盲276人,其中男性120人(占43.48%)、女性156人(占56.52%).重度双眼盲、轻度双眼盲、单眼盲的患病率分别为1.58%、1.71%和7.17%.致盲的主要原因依次为:黄斑变性、白内障、屈光不正及角膜瘢痕或混浊.结论 黄斑变性仍是致盲的首要原因,眼底病患病率逐渐上升,社区防盲项目已初显成效.     

上海市北新泾街道老年人高度近视眼的流行病学调查

目的 了解上海市北新泾街道60岁及以上老年人高度近视眼患病率、高度近视眼视网膜脉络膜病变的患病率及其相关影响因素.方法 采用整群随机分层抽样法,对上海市北新泾街道的4153位60岁及以上老年人进行人群普查,受检者3851例,受检率为92.73%.现场调查内容为问卷调查及全面的眼科检查,包括视力、屈光度、裂隙灯显微镜、直接检眼镜检查和眼底照相等.屈光不正用等效球镜度数(SE)表示.若受检者SE>-6.00 D,眼底表现有后巩膜葡萄肿、漆纹样裂纹、Fuchs斑、近视弧形斑等近视性视网膜脉络膜萎缩病灶则诊断为高度近视眼视网膜脉络膜病变.小孔视力按照WHO视力损伤分级:最佳矫正视力≥0.05但<0.3为低视力,<0.05为盲.结果 受检者中,高度近视眼207例,占5.37%.其中,183例表现高度近视性视网膜脉络膜病变,占88.40%.随年龄的增长,高度近视眼视网膜脉络膜病变的患病率显著下降(X2=19.21,P<0.01),但男女之间患病率差异无统计学意义(X2=1.83,P>0.05).Logistic回归分析显示,不同年龄、不同文化程度、有无高度近视眼家族史人群的患病率差异均有统计学意义(X2=19.21,32.08,960.68;P<0.01).受检者中,双眼盲29例,单眼盲96例,双眼低视力104例,单眼低视力562例.183例高度近视眼视网膜脉络膜病变患者中,111例存在明显的视力损伤,占60.65%,其中,双眼盲、单眼盲、双眼低视力、单眼低视力的患者分别为10例,11例、31例和59例,分别占总受检人群中视力损伤者的34.48%、11.46%、29.81%和10.50%.结论上海市北新泾地区老年人高度近视眼的患病率较高.年龄、文化程度,高度近视眼家族史是影响高度近视眼视网膜脉络膜病变的重要因素.     

上海北新泾老人白内障流行病学调查

目的:调查上海北新泾街道60岁及以上人群白内障患病率、白内障盲人手术覆盖率和白内障盲人社会负担率。方法:随机整群抽样,对所有60岁及以上人群进行视力和眼部检查。了解接受白内障手术情况。结果:受检者3851例,白内障患病率39.86%。以双眼日常生活视力<0.1为盲的标准,白内障盲人手术覆盖率84.60%,白内障盲人的社会负担率3.87%,女性和文盲分别为4.65%和8.01%。结论:白内障盲人的社会负担率较重,女性和文盲白内障是严重的公共卫生问题。根治白内障盲仍是防盲工作的重要任务。     

上海市北新泾社区糖尿病视网膜病变远程筛查系统的应用研究

目的 探讨社区糖尿病视网膜病变(DR)远程筛查系统的应用效果.方法 横断面研究.以免散瞳数码眼底照相机和计算机网络技术为基础,构建社区DR远程筛查系统.采用随机数字表法抽取109例已进入筛查系统的糖尿病居民进行系统评价.评价内容:1)经过培训的视力检查员和眼科医师对同一患者双眼远视力检查结果的一致性,采用配对t检验进行分析;不同眼病的分析人员分别按该系统中免散瞳眼底照相的读片法和散瞳后应用检眼镜、裂隙灯显微镜联合90D非接触镜检查法(传统检查法),对同一患者双眼DR诊断和分级结果的一致性进行评价,采用kappa值和组内相关系数进行分析;(2)对眼底照相获取的图像进行不同比例的压缩,通过该系统网络传输后,采用组内相关系数分析压缩后的图像质量,获得合适的压缩比例;(3)计算筛查系统运行所需的时间,并与传统检杳法进行比较.结果 109例(218只眼)受检者中,由眼科医师检查获取的视力分布情况:力<0.05者13只眼,视力0.05～0.3者61只眼,视力≥0.3者144只眼,与其他检查人员的视力检查结果比较,差异无统计学意义(t=-0.572,P=0.568).采用传统检杳法与眼底照相法诊断为DR的眼数相同,均为52只眼,两者间比较的kappa值为0.885,95%可信区间为0.807～0.963;DR不同分级诊断的一致性:内相关系数为0.91,95%可信区间为0.85～0.94,表明两者的一致性好.将眼底照相获取的图像,以最大限度压缩至原始图像的15%(526×350像素)时,图像清晰度仍不受影响.每位受检者实时远程筛查所需的时间为5～7 min,略少于传统检查法所需时间.结论 社区DR远程筛查系统可满足DR患者筛查的需求.     

上海市北新泾街道60岁及其以上居民糖尿病视网膜病变患病情况调查

目的　调查60岁及其以上糖尿病患病居民糖尿病视网膜病变（DR）患病情况和影响因素,并与2003年在同区域开展的DR调查结果进行比较分析。方法　2007年11月至2008年4月在上海市北新泾街道开展人群普查。对≥60岁糖尿病居民进行全身、视力、裂隙灯显微镜、直接和（或）间接检眼镜检查,免散瞳数字眼底照相机拍摄后极部45°范围内2个不同区域内的照片。采用多人分别独立读片的方式,根据2002年国际DR分型标准确立DR的诊断。在曾进入2003年流行病学调查的≥60岁糖尿病居民中随访到254例,将本次调查情况与前次调查结果进行对比。采用卡方检验统计分析与患病率相关的影响因素,通过逐步回归分析筛选出独立影响因素。结果　实际受检人数483例,受检率为91.30%。其中,DR患者121例,患病率为25.05%。非增生型DR和增生型DR的患病率分别为22.36%和2.69%。糖尿病病程是影响糖尿病患者DR患病率的独立因素。未发现影响非增生型DR和增生型DR构成比差异的因素。参加前后2次调查的254例糖尿病居民DR程度稳定或改善的比例达到92.52%。结论　≥60岁糖尿病居民中DR患病率高;已在该社区开展的DR防盲 措施已初显成效。     

恶性肿瘤社区随访模式的研究进展

恶性肿瘤是影响中国居民健康的重要疾病,社区恶性肿瘤随访工作对提高患者预后和生活质量日益重要。本文对国内外社区恶性肿瘤随访模式相关研究进行综述,阐述社区恶性肿瘤随访模式的研究现状、特点和形式,在此基础上提出对国内社区恶性肿瘤随访模式研究的思考,以及对实践的启示。     

上海市北新泾街道老年人年龄相关性黄斑变性的患病率调查

目的 调查上海市北新泾街道≥60岁人群中年龄相关性黄斑变性(AMD) 的患病情况。方法 于2007年11月—2008年4月,采用整群抽样的方法对上海市北新泾街道≥60岁的居民进行AMD患病率和相关因素的调查。调查内容包括一般资料、既往眼病诊断和治疗史、日常生活视力和针孔矫正视力;进行眼科基本检查,并采用眼底照相机拍摄后极部45°范围内2个不同区域内的照片。由2名以上医师独立读片确立AMD的诊断;AMD的分类采用全国眼底病学组指定的标准。结果 本调查共纳入4 153人,实际受检3 571人,受检率85.99%。确诊AMD患者477例(778眼),占受检人群的13.36%。确诊湿性AMD患者64例(85眼),占受检人群的1.79%。在60～69、70～79、80岁以上各年龄段人群中,AMD的检出率分别为6.23%、14.98%和29.91%,差异有统计学意义(χ2=169.40,P<0.01);在文盲、小学、中学及中学以上不同受教育程度人群中,AMD的检出率分别为15.2%、18.75%、9.36%和8.22%,差异有统计学意义(χ2=59.56,P<0.01);AMD在男性与女性人群中的患病率比较差异无统计学意义（χ2=0.03,P>0.05）。AMD眼中,盲和低视力的比例分别为3.08%和18.51%。湿性AMD眼中,盲和低视力的比例为15.29%和32.95%,分别高于干性AMD眼的1.59%和16.73%。结论 AMD的患病率随着年龄增长而显著升高,随着受教育程度的提高而显著下降,严重影响患者视力。