摘要：

目的: 筛查库欣病患者视力视野障碍相关危险因素，并基于危险因素行卫生经济学分析。方法: 纳入1994年8月至2019年12月中国医学科学院北京协和医院收治的416例库欣病患者，以视力视野客观检查为因变量，以性别、年龄、病程、血糖、血压、激素水平、眼部肿胀、影像学特征、视力视野主诉为自变量，采用单因素和多因素前进法Logistic回归分析筛查视力视野障碍相关危险因素，并基于危险因素行卫生经济学成本-效果分析和成本-效益分析。结果: 共416例库欣病患者，视力视野主诉异常143例（34.38%），包括视物模糊59例、视力下降11例、视物模糊合并视力下降41例、视物模糊合并视野缺损13例、视力下降合并视野缺损3例、三者并存16例；视力视野客观检查异常102例（24.52%），包括视力下降44例、视野缺损39例、视力下降合并视野缺损19例。Logistic回归分析显示，服药后收缩压升高（OR=1.016，95% CI：1.002~1.030；P=0.025）和视力视野主诉异常（OR=14.000，95% CI：7.918~24.754；P=0.000）是视力视野障碍的主要危险因素。卫生经济学分析，全组患者成本-效果比为393 926.53，是视力视野主诉异常患者（60 057.93）的6.56倍；成本-效益比为4.08，是视力视野主诉异常患者（1.81）的2.25倍。结论: 视力视野主诉异常的库欣病患者更易发生视力视野客观检查异常，因此以视力视野主诉异常作为库欣病患者视力视野客观检查的指征，可提高检出率并减少卫生资源和社会资源浪费，不仅具有临床可行性，而且可以有效预防医疗风险。

关键词: 库欣综合征, 视力测定法, 视野测试, 视觉障碍, 危险因素, 经济学，医学

Abstract:

Objective: To screen risk factors related to visual acuity and visual field defects in patients with Cushing's disease, and based on risk factors to analyze health economics. Methods: A total of 416 patients with Cushing's disease admitted to Peking Union Medical College Hospital, Chinese Academy of Medical Sciences from August 1994 to December 2019 were included. Objective examination of visual acuity and visual field was used as the dependent variable, while gender, age, duration, blood glucose, blood pressure, hormone level, eye swelling, imaging features, and main complaint of visual acuity and visual field were used as independent variables. Univariate and multivariate Logistic regression analysis was used to screen the risk factors related to visual acuity and visual field defects, and cost-effectiveness ratio (CER) and cost-benefit ratio (CBR) were analyzed based on risk factors. Results: Among 416 patients with Cushing's disease, 143 (34.38%) complained of abnormal visual acuity and visual field, including 59 cases of blurred vision, 11 cases of impaired visual field, 41 cases of blurred vision combined with impaired visual field, 13 cases of blurred vision combined with impaired visual field, 3 cases of impaired visual field combined with impaired visual field, and 16 cases of all three symptoms. There were 102 cases (24.52%) with abnormal visual acuity and visual field test, including 44 cases of visual loss, 39 cases of visual field defect, and 19 cases of visual loss combined with visual field defect. Logistic regression analysis showed the increased systolic blood pressure (OR=1.016, 95%CI: 1.002-1.030; P=0.025) and abnormal visual acuity and visual field complaints (OR=14.000, 95%CI: 7.918-24.754; P=0.000) were risk factors for visual acuity and visual field defects. According to the analysis of health economics, the CER of the whole group was 393 926.53, which was 6.56 times higher than that of the patients with abnormal visual acuity and visual field complaints (60 057.93). The CBR was 4.08, which was 2.25 times higher than that of patients with abnormal visual acuity and visual field complaints (1.81). Conclusions: Cushing's disease patients with abnormal visual acuity and visual field complaints are more likely to have abnormal visual acuity and visual field. Therefore, taking abnormal visual acuity and visual field complaints as an indication for visual acuity and visual field test of Cushing's disease patients can improve the detection rate and reduce the waste of health and social resources, which is not only clinically feasible, but also can effectively prevent medical risks.

Key words: Cushing syndrome, Optometry, Visual field tests, Vision disorders, Risk factors, Economics, medical