生命早期及儿童期影响因素对年龄相关性白内障的影响

Influence of early-life and childhood exposures on age-related cataract

摘要:

目的：评价生命早期及儿童期影响因素与成人年龄相关性白内障(age-related cataract，ARC)发病的关系，为早期预防、早期发现、早期治疗ARC提供理论依据。

方法：我院2011-04/2012-10开展以医院为基础的病例对照研究，病例由41～60岁的360例360眼施行白内障摘除术的患者所组成。对照组由与病例的年龄和性别进行匹配、因罹患各种与ARC无关的疾病、同期入住相同医院的360例非白内障的患者所组成。采用自制的调查问卷对所有研究对象进行调查，包括研究对象的一般状况、生命早期影响因素，以及儿童期暴露因素。采用非条件Logistic回归模型对结果进行分析。

结果：出生时胎龄越早，出生时体质量越低，均与发生ARC的危险性具有显著性关联(分别为OR =1.152，95%CI：1.029～2.235，P=0.024； OR=1.374，95%CI：1.156～2.581，P=0.037)； 母亲孕前糖尿病(OR=1.587，95%CI：1.177～2.915，P =0.019)、孕期糖尿病(OR =1.763，95%CI：1.375～2.367，P =0.004)、先兆子痫(OR=1.581，95%CI：1.139～1.996，P=0.021)，以及妊娠期高血压(OR=1.517，95%CI：1.032～1.963，P=0.024)均可使发生ARC的危险性升高； 而儿童期的影响因素只有10岁时的身高低于同龄儿童和体质量高于同龄儿童才与发生ARC危险性具有十分显著性关联(分别为OR=1.329，95%CI：1.072～2.351，P=0.038； OR=2.302，95%CI：1.323～3.196，P=0.011)。

结论：出生时胎龄越早、低体质量出生、母亲孕前糖尿病、孕期糖尿病、先兆子痫、妊娠期高血压、10岁时身高较矮，以及体质量升高均是ARC发病的危险因素。但需要进一步开展历时长、大规模的前瞻性研究，以证实我国人群ARC的早期危险因素。

Abstract:

AIM: To evaluate the relationship of early-life and childhood exposures and age-related cataract(ARC), and provide a scientific evidence for early preventing, treating and detecting ARC.

METHODS: A hospital-based case control study was conducted from April 2011 to October 2012.A total of 360 cases(360 eyes)aged 41～60 years old for cataract extraction and 360 frequency-matched controls in the same hospital for various not related to ARC were included in the study. A structured interviewer-administrated questionnaire that included information on sociodemographic characteristics, early-life and childhood exposures was used. The risk factors of ARC were estimated with unconditioned logistic regression models.

RESULTS:Early gestational age at birth sooner and lower birth weight was significantly associated with the risk of ARC(OR=1.152,95%CI:1.029～2.235,P=0.024; OR=1.374, 95%CI:1.156～2.581,P=0.037,respectively). The maternal pre-pregnancy diabetes(OR=1.587, 95%CI:1.177～2.915,P=0.019),gestational diabetes(OR=1.763,95%CI:1.375～2.367,P=0.004), preeclampsia(OR=1.581, 95%CI: 1.139～1.996,P=0.021), and pregnancy induced hypertension(OR=1.517, 95%CI:1.032～1.963,P=0.024)could make the risk of ARC increased. Of the factors affecting the period of children, only shorter height relative to peers and overweight at age 10 were significantly associated with the risk of ARC(OR=1.329, 95%CI:1.072～2.351,P=0.038; OR=2.302, 95%CI:1.323～3.196,P=0.011, respectively).

CONCLUSION:Early gestational age at birth, low birth weight, the maternal pre-pregnancy diabetes, gestational diabetes, preeclampsia, and gestational hypertension, and shorter height and overweight relative to peers, at age 10 were risk factors of ARC. But lasted long large and prospective studies are needed to insure early risk factors for ARC in the Chinese population.