| 作者：Allison Gandey | | 出處：WebMD醫學新聞 |
October 23, 2008 — 迄今最大型的自發性顱內高壓研究發現，男性發生視力損失的風險為女性的兩倍；研究結果線上登載於10月15日的神經學期刊。
主要研究者、Emory大學的Beau Bruce醫師在新聞稿中表示，雖然男性比較少發生顱內高壓，但是相較於女性，男性發生嚴重視力損失的頻率增加，這相當值得關注。
他指出，我們的發現認為，有此狀況的男性應該更仔細監控他們的視力，且於出現視力損失現象時積極治療。
該研究也發現，男性比較可能發生睡眠呼吸中止；Bruce醫師表示，需要更多前溯研究來評估睡眠呼吸中止對於治療顱內高壓的影響，而醫師應將受此影響的男性和女性病患都納入睡眠研究。
愛荷華大學的Michael Wall醫師和印第安那大學醫學中心的Valerie Purvin醫師在編輯評論中寫道，希望大家記住的是，符合Dandy氏標準的男性應廣被評估引起顱內高壓的原因，包括阻塞性睡眠呼吸中止(OSA)。
他們認為，更緊密監控這些病患的視力功能且更積極治療他們是謹慎的做法，這包括確認並積極治療睡眠呼吸中止。
研究者研究了Emory大學、密西西比大學、偉恩州立大學共721名病患的醫療紀錄，研究者收集人口統計學、聯合因素與視力功能等的現況並追蹤。
研究中，男性平均年紀大於女性(37歲vs. 28歲; P=.02)，在最初的神經-眼科評估中，相較於女性，男性比較不會將頭痛報告為最初症狀，且後續也較少指出有頭痛(79% vs. 89%; P=.01)。
【顱內高壓病患之間的症狀比較】 症狀 | 男性、 66 人(%) | 女性、 655 人(%) | P | 睡眠呼吸中止 | 24 | 4 | <.001 | 頭痛 | 55 | 75 | <.001 | 視力困擾 | 35 | 20 | .005 |
Bruce醫師等人表示，男性在現況與追蹤時的視力及視野都顯著較差；相較於女性，男性至少單眼嚴重視力損失相對風險為2.1倍 (95% CI, 1.4 – 3.3; P=.002)，雙眼為2.1倍(95% CI, 1.1 – 3.7; P=.03)。
研究者報告指出，邏輯回歸支持性別是嚴重視力損失的獨立風險因素。
Wall醫師和Purvin醫師寫道，Bruce醫師等人報告指出24%男性的睡眠研究符合阻塞性睡眠呼吸中止的標準，但是我們不知道其他的76%有多少人是多頻道睡眠檢查陰性，因此，睡眠呼吸中止的實際發生率是被低估的；這很重要，因為睡眠呼吸中止和顱內高壓之間的關係是相當複雜的。
作者結論表示，校正年紀、睡眠呼吸中止診斷、頭痛是顱內高壓的最初徵兆等因素之後，男性依舊是嚴重視力損失的獨立風險因素。
編輯指出，雖然他們的結論有統計清楚支持，但睡眠呼吸中止很可能未被診斷。藉由收集前溯資料，或許可以發現，造成視力不佳結果的原因可能是睡眠呼吸中止，而非男性。
但是編輯也指出，若不論機轉，顱內高壓男性應該要有更好的視力結果。
本研究接受防盲研究與國家健康研究中心的支持。研究者宣稱沒有相關資金的往來。
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Men With Idiopathic Intracranial Hypertension at Risk for Vision Loss
By Allison Gandey
Medscape Medical News
October 23, 2008 — Men are twice as likely as women to develop severe vision loss, the largest study to date looking at idiopathic intracranial hypertension has found. Results are published online October 15 in Neurology.
"While intracranial hypertension occurs less often in men, their increased frequency of severe vision loss compared with women is a major concern," lead investigator Beau Bruce, MD, from Emory University, in Atlanta, Georgia, said in a news release.
"Our findings suggest that men with this condition should have more careful monitoring of their eyesight and likely should be treated more aggressively when they do have evidence of vision loss," he added.
The study also found men were more likely to have sleep apnea. Dr. Bruce says that more prospective studies are needed to evaluate the role of sleep apnea in the treatment of patients with intracranial hypertension, but that clinicians should consider referring affected patients — both men and women — for sleep studies.
While intracranial hypertension occurs less often in men, their increased frequency of severe vision loss is a major concern. "The take-home message is that men who meet the Dandy criteria should be extensively evaluated for causes of intracranial hypertension, including obstructive sleep apnea," Michael Wall, MD, from the University of Iowa, in Iowa City, and Valerie Purvin, MD, from Indiana University Medical Center, in Indianapolis, write in an accompanying editorial.
They suggest that it is prudent to follow visual function more closely in these patients and be more aggressive in treating them. This includes identifying and vigorously treating sleep apnea when present.
Investigators studied medical records for 721 consecutive patients from Emory University, the University of Mississippi, and Wayne State University. Researchers collected demographics, associated factors, and visual function at presentation and follow-up.
Men were on average older than the women in the study (37 years vs 28; P?=?.02). Men were less likely to report headache as a first symptom and continued to report fewer headaches than women at initial neuro-ophthalmologic assessment (79% vs 89%; P?=?.01)
Symptom Comparison Between Patients With Intracranial Hypertension | Symptom | Men, n=66 (%) | Women, n=655 (%) | P | | Sleep apnea | 24 | 4 | <.001 | | Headache | 55 | 75 | <.001 | | Visual disturbances | 35 | 20 | .005 |
Dr. Bruce and his team demonstrate that visual acuity and fields at presentation and last follow-up were significantly worse among men. The relative risk of severe visual loss for men compared with women was 2.1 (95% CI, 1.4 – 3.3; P?=?.002) for at least 1 eye and 2.1 (95% CI, 1.1 – 3.7; P?=?.03) for both eyes.
The researchers report that logistic regression supported sex as an independent risk factor for severe visual loss.
"Bruce et al report that 24% of the men had sleep studies that met criteria for obstructive sleep apnea," Drs. Wall and Purvin write. "But we do not know how many of the remaining 76% had negative polysomnography. Thus, the actual incidence of sleep apnea was likely underestimated. This is important because of the complex relationship between sleep apnea and intracranial hypertension."
The authors conclude that male sex remains an independent risk factor for severe visual loss in at least 1 eye when adjusted for age, diagnosis of sleep apnea, and headache as first sign of intracranial hypertension.
"While their conclusions are clearly supported statistically," the editorialists note, "sleep apnea was likely underdiagnosed. With prospective data collection, we might find that the reason for the poor visual outcome is sleep apnea rather than being male."
But regardless of the mechanism, the editorialists point out, better visual outcomes should be observed in men with intracranial hypertension.
The study was supported by a grant from Research to Prevent Blindness and the National Institutes of Health. The researchers have disclosed no relevant financial relationships.
Neurology. Published online October 15, 2008. Abstract Abstract
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[ 本帖最後由 goodcat1111 於 2008-11-4 12:49 編輯 ] |
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