Demographic, Systemic, and Ocular Factors Associated with Nonarteritic Anterior Ischemic Optic Neuropathy
Demographic, Systemic, and Ocular Factors Associated with Nonarteritic Anterior Ischemic Optic Neuropathy
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DOI：
10.1016/j.ophtha.2016.08.017
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发表时间：
2016-12-01
期刊：
影响因子：
13.7
通讯作者：
Stein, Joshua D.
中科院分区：
文献类型：
--
作者：
Cestari, Dean M.;Gaier, Eric D.;Stein, Joshua D.
目的：非动脉炎性前部缺血性视神经病变(NAION)是一种导致永久性视力丧失的严重眼部疾病。人们对这种疾病的风险因素知之甚少。我们评估了与NAION相关的人口、系统和眼睛因素。设计：回溯性纵向队列研究。参与者：在一个大型的美国管理医疗网络中登记的基线年龄在40岁到75岁之间没有NAION的受益者。方法：从2001年到2014年，连续监测参与者>；=2年，以确定那些新诊断为NAION的人(国际疾病分类，第9版，临床修改[ICD-9-CM]代码377.41)。所有患者都接受眼部监测，所有病例在随访期间都有NAION的>；=1确认性ICD-9-CM编码。主要观察指标：采用多变量Cox回归模型生成风险比(HR)，可信区间(CI)为95%，以描述选定的人口学特征、全身和眼部状况与发生NAION的风险之间的统计关系。结果：在1381 477名符合条件的入选者中，977人(0.1%)在7.8+/-3.1年的平均+/-标准差(SD)随访期间发生了NAION。在索引日期，NAION病例的平均+/-SD年龄为64.0+/-9.2岁，而其余受益人为58.4+/-9.4岁。在调整混杂因素后，年龄每增加一岁，患NAION的风险增加2%(HR=1.02；95%CI：1.01-1.03)。与男性受试者相比，女性受试者患NAION的风险降低36%(HR=0.64；95%CI：0.55~0.74)。与白人相比，拉丁裔患NAION的风险降低46%(HR=0.54；95%CI：0.36-0.82)，而非洲血统与NAION没有显著关联(HR=0.91；95%CI：0.72-1.15)。与NAION相关的全身疾病包括高血压(HR=1.62；95%CI：1.26~2.07)和高凝状态(HR=2.46；95%CI：1.51~4.00)。尽管糖尿病与NAION的相关性不明显(P=0.45)，但有终末器官受累的DM患者NAION的风险比无并发症的DM患者高27%(HR=1.27；95%CI：1.01~1.59)。与NAION相关的眼病有年龄相关性黄斑变性(HR=1.29；95%CI：1.08~1.54)和视网膜静脉阻塞(HR=3.94；95%CI：3.11~4.99)。如果未来的研究证实了这些发现，它们可能会提供预防或治疗这种衰弱疾病的机会。(C)2016年度美国眼科学会
Objective: Nonarteritic anterior ischemic optic neuropathy (NAION) is a devastating ocular condition causing permanent vision loss. Little is known about risk factors for developing this disease. We assessed demographic, systemic, and ocular factors associated with NAION.Design: Retrospective longitudinal cohort study.Participants: Beneficiaries between 40 and 75 years old without NAION at baseline enrolled in a large U.S. managed care network.Methods: Enrollees were monitored continuously for >= 2 years between 2001 and 2014 to identify those newly diagnosed with NAION (International Classification of Diseases, 9th Revision, Clinical Modification [ICD-9-CM] code 377.41). All persons were under ophthalmic surveillance and all cases had >= 1 confirmatory ICD-9-CM code for NAION during follow-up.Main Outcome Measures: Multivariable Cox regression modeling was used to generate hazard ratios (HRs) with 95% confidence intervals (CIs) to describe the statistical relationship between selected demographic characteristics, systemic and ocular conditions, and the hazard of developing NAION.Results: Of 1 381 477 eligible enrollees, 977 (0.1%) developed NAION during a mean +/- standard deviation (SD) follow-up of 7.8+/-3.1 years. The mean +/- SD age for NAION cases at the index date was 64.0+/-9.2 years vs. 58.4+/-9.4 years for the remainder of the beneficiaries. After adjustment for confounding factors, each additional year older was associated with a 2% increased hazard of NAION (HR = 1.02; 95% CI: 1.01-1.03). Female subjects had a 36% decreased hazard of developing NAION (HR = 0.64; 95% CI: 0.55-0.74) compared with male subjects. Compared with whites, Latinos had a 46% decreased hazard of developing NAION (HR = 0.54; 95% CI: 0.36-0.82), whereas African ancestry was not significantly associated with NAION (HR = 0.91; 95% CI: 0.72-1.15). Systemic diseases associated with NAION included hypertension (HR = 1.62; 95% CI: 1.26-2.07) and hypercoagulable states (HR = 2.46; 95% CI: 1.51-4.00). Although diabetes mellitus (DM) was not significantly associated with NAION compared with those without DM (P = 0.45), patients with end-organ involvement from DM had a 27% increased hazard of NAION relative to those with uncomplicated DM (HR = 1.27; 95% CI: 1.01-1.59). Ocular diseases associated with NAION were age-related macular degeneration (HR = 1.29; 95% CI: 1.08-1.54) and retinal vein occlusion (HR = 3.94; 95% CI: 3.11-4.99).Conclusions: Our study identified several modifiable risk factors that may be associated with NAION. Should future studies confirm these findings, they may offer opportunities to prevent or treat this debilitating condition. (C) 2016 by the American Academy of Ophthalmology