Shengjie Li1, Haichen Zhang2, Mingxi Shao3, Yingzhu Li3, Yunxiao Song2, Xinghuai Sun4, Wenjun Cao5. 1. Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China. 2. Department of Clinical Laboratory, Shanghai Xuhui Central Hospital, Shanghai, China. 3. Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China. 4. Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China. 5. Department of Clinical Laboratory, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China; Department of Ophthalmology & Visual Science, Eye & ENT Hospital, Shanghai Medical College, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Institutes of Brain Science, Fudan University, Shanghai, China; Key Laboratory of Myopia, Chinese Academy of Medical Sciences, Shanghai, China; NHC Key Laboratory of Myopia, Fudan University, Shanghai, China. Electronic address: wgkjyk@aliyun.com.
Abstract
PURPOSE: To investigate an association between sex hormones and inflammatory cytokines, and to determine whether baseline 17-β-estradiol (E2) and interleukin (IL)-8 are associated with visual field (VF) progression in postmenopausal women with primary angle closure glaucoma (PACG). DESIGN: A prospective cross-sectional and cohort study. PARTICIPANTS: The cross-sectional study enrolled 200 postmenopausal women with PACG and 151 healthy postmenopausal women as normal controls. A total of 105 postmenopausal women with PACG were included and followed up for at least 2 years in the cohort study. METHODS: All participants were evaluated for levels of baseline sex hormones (follicle-stimulating hormone, prolactin, progesterone, testosterone, luteinizing hormone, and E2) and inflammatory cytokines (IL-1, IL-2, IL-6, IL-8, IL-10, and CRP) and underwent VF examinations. The cross-sectional study was conducted to establish risk factors for postmenopausal women with PACG using logistic regression analysis. The cohort study was designed to identify the factors, which could be used to predict VF progression in postmenopausal women with PACG using multivariate Cox regression analyses. MAIN OUTCOME MEASURES: Factors associated with VF progression over time. RESULTS: Decreased E2 (OR=0.88, 95% CI=0.78-0.99, p=0.007) and increased IL-8 (OR=1.12, 95% CI=1.01-1.23, p<0.001) levels were risk factors in postmenopausal women with PACG. A significant negative correlation was observed between IL-8 levels and E2 (r=-0.21, p=0.02). Multivariable regression analyses revealed a significant correlation between E2 levels and visual field mean deviation (MD) (B=-0.16, p=0.04, 95% CI=-0.09--0.003), and between IL-8 levels and MD (B=0.36, p<0.001, 95% CI=0.01-0.02). During follow-up, 48 (45.71%) patients showed VF progression. Lower baseline E2 (hazard ratio [HR]=0.85, 95% CI=0.82-0.88, p=0.04) and higher baseline IL-8 levels (HR=1.01, 95% CI=1.00-1.02, p=0.004) were associated with progression of glaucoma. Patients with lower E2 levels had a significantly higher rate of PACG progression (log-rank test p<0.001), similar to those with higher IL-8 levels (log-rank test p=0.04). CONCLUSIONS: Decreased E2 and increased IL-8 levels at baseline are significant predictors of VF progression in postmenopausal women with PACG.
PURPOSE: To investigate an association between sex hormones and inflammatory cytokines, and to determine whether baseline 17-β-estradiol (E2) and interleukin (IL)-8 are associated with visual field (VF) progression in postmenopausal women with primary angle closure glaucoma (PACG). DESIGN: A prospective cross-sectional and cohort study. PARTICIPANTS: The cross-sectional study enrolled 200 postmenopausal women with PACG and 151 healthy postmenopausal women as normal controls. A total of 105 postmenopausal women with PACG were included and followed up for at least 2 years in the cohort study. METHODS: All participants were evaluated for levels of baseline sex hormones (follicle-stimulating hormone, prolactin, progesterone, testosterone, luteinizing hormone, and E2) and inflammatory cytokines (IL-1, IL-2, IL-6, IL-8, IL-10, and CRP) and underwent VF examinations. The cross-sectional study was conducted to establish risk factors for postmenopausal women with PACG using logistic regression analysis. The cohort study was designed to identify the factors, which could be used to predict VF progression in postmenopausal women with PACG using multivariate Cox regression analyses. MAIN OUTCOME MEASURES: Factors associated with VF progression over time. RESULTS: Decreased E2 (OR=0.88, 95% CI=0.78-0.99, p=0.007) and increased IL-8 (OR=1.12, 95% CI=1.01-1.23, p<0.001) levels were risk factors in postmenopausal women with PACG. A significant negative correlation was observed between IL-8 levels and E2 (r=-0.21, p=0.02). Multivariable regression analyses revealed a significant correlation between E2 levels and visual field mean deviation (MD) (B=-0.16, p=0.04, 95% CI=-0.09--0.003), and between IL-8 levels and MD (B=0.36, p<0.001, 95% CI=0.01-0.02). During follow-up, 48 (45.71%) patients showed VF progression. Lower baseline E2 (hazard ratio [HR]=0.85, 95% CI=0.82-0.88, p=0.04) and higher baseline IL-8 levels (HR=1.01, 95% CI=1.00-1.02, p=0.004) were associated with progression of glaucoma. Patients with lower E2 levels had a significantly higher rate of PACG progression (log-rank test p<0.001), similar to those with higher IL-8 levels (log-rank test p=0.04). CONCLUSIONS: Decreased E2 and increased IL-8 levels at baseline are significant predictors of VF progression in postmenopausal women with PACG.