肝豆状核变性患者角膜K-F环分级与焦虑抑郁程度的相关性分析

李慧; 何伟; 黄学海; 陈义

doi:10.12449/JCH251220

肝豆状核变性患者角膜K-F环分级与焦虑抑郁程度的相关性分析

DOI: 10.12449/JCH251220

安徽中医药大学第一附属医院眼科，合肥 230001

基金项目:

国家自然科学基金（区域创新发展联合基金） (U22A20366)

伦理学声明：本研究于2021年9月15日经由安徽中医药大学第一附属医院医学伦理委员会审批，批号：2021AH-60，患者均签署知情同意书。

利益冲突声明：本文不存在任何利益冲突。

作者贡献声明：李慧负责设计论文框架，资料收集分析及撰写论文；何伟、黄学海参与数据收集及分析；陈义负责论文修改，指导撰写论文并最后定稿。

详细信息

通信作者:
陈义， chenyi@azyfy.com （ORCID： 0009-0004-4568-9144）

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出版历程
- 收稿日期: 2025-07-14
- 录用日期: 2025-09-11
- 出版日期: 2025-12-25

Association between corneal Kayser-Fleischer ring grading and the degree of anxiety-depression in patients with Wilson’s disease

Department of Ophthalmology，The First Affiliated Hospital of Anhui University of Chinese Medicine，Hefei 230001，China

Research funding:

National Natural Science Foundation of China（Joint Fund for Regional Innovation and Development） (U22A20366)

More Information

Corresponding author: CHEN Yi， chenyi@azyfy.com （ORCID： 0009-0004-4568-9144）

摘要

摘要: 目的探究角膜Kayser-Fleischer环（K-F环）不同分级对肝豆状核变性患者焦虑抑郁程度的影响。方法选取2012年8月—2020年2月安徽中医药大学第一附属医院眼科会诊的WD患者107例，在裂隙灯显微镜下进行角膜K-F环检查分级，分为0～4级。指导患者完成汉密尔顿焦虑量表（HAMA）和汉密尔顿抑郁量表（HAMD）测评，分析K-F环不同的分级与两个量表之间的差异及相关性。符合正态分布的计量资料多组间比较采用方差分析，进一步两两比较采用LSD-t或Dunnett’s T3检验。非正态分布的计量资料多组间比较采用Kruskal-Wallis H检验，进一步两两比较采用Bonferroni法。采用Spearman相关性分析将K-F环分级与HAMA、HAMD评分进行相关性分析。结果 107例WD患者中K-F环最少的为0级5例（4.6%），最多的为4级44例（41.1%），另有1级18例（16.8%）、2级24例（22.4%）、3级16例（14.9%）。按照不同K-F环分级，HAMA评分、HAMD评分呈上升趋势（F值分别为16.340、12.760，P值均<0.001）。Spearman相关性分析发现K-F环分级与HAMA评分、HAMD评分呈正相关（r值分别为0.528 9、0.480 1，P值均<0.01）。结论角膜K-F环分级同HAMD、HAMA量表评分具有一定的相关性，可部分反映患者焦虑抑郁的程度。因此，临床医生应重视角膜K-F环的检查及其与临床症状的关系。
- 肝豆状核变性 /
- 汉密尔顿焦虑量表 /
- 汉密尔顿抑郁量表 /
- 焦虑
Abstract: Objective To investigate the impact of different grades of corneal Kayser-Fleischer （K-F） ring on the severity of anxiety and depression in patients with Wilson’s disease （WD）. Methods A total of 107 patients with WD who received consultation in Department of Ophthalmology， The First Affiliated Hospital of Anhui University of Chinese Medicine， from August 2012 to February 2020 were enrolled， and a slit-lamp microscope was used to determine the grade of corneal K-F ring （grades 0 — 4）. The patients were instructed to complete Hamilton Anxiety Scale （HAMA） and Hamilton Depression Scale （HAMD） assessments， and the correlation between K-F ring grade and the scores of the two scales was analyzed， as well as the differences in the scores of the two scales between the patients with different K-F ring grades. An analysis of variance was used for comparison of normally distributed continuous data between multiple groups， and the least significant difference t-test or the Dunnett’s T3 test was used for further comparison between two groups； the Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups， and the Bonferroni method was used for further comparison between two groups. The Spearman correlation analysis was used to investigate the correlation between K-F ring grade and HAMA/HAMD score. Results Among the 107 patients with WD， the patients with grade 0 K-F ring accounted for the lowest proportion of 4.6% （5/107）， while the patients with grade 4 K-F ring accounted for the highest proportion of 41.1% （44/107）， and the patients with grade 1 K-F ring， grade 2 K-F ring， and grade 3 K-F ring accounted for 16.8% （18/107）， 22.4% （24/107）， and 14.9% （16/107）， respectively. HAMA and HAMD scores tended to increase with the increase in K-F ring grade （F=16.340 and 12.760， both P <0.001）. The Spearman correlation analysis showed that K-F ring grade was positively correlated with HAMA and HAMD scores （r=0.528 9 and 0.480 1， both P<0.01）. Conclusion There is a certain correlation between corneal K-F ring grading and HAMD/HAMA scores， which can partially reflect the severity of anxiety and depression in patients. Therefore， clinicians should emphasize K-F ring examination and its association with clinical symptoms.
- Hepatolenticular Degeneration /
- Hamilton Anxiety Scale /
- Hamilton Depression Scale /
- Anxiety

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注： a，0级角膜无K-F环；b，1级K-F环于角膜缘上方和下方呈点状分布；c，2级K-F环局限于角膜缘上方和下方呈月牙形分布，未形成完整的环；d，3级K-F环于角膜四周形成完整的圆环，最大宽度<2 mm；e，4级K-F环于角膜四周形成圆环状，最大宽度>2 mm，且晶体前囊膜下可见颗粒沉着；f，与K-F环鉴别的老年环，位于角膜边缘，脂质在角膜基质层沉积，为灰白色环形浑浊。

图 1 不同K-F环分级及老年环例图

Figure 1. Examples of different K-F ring grading and arcus senili

下载: 全尺寸图片幻灯片

表 1 各组患者一般资料比较

Table 1. Comparison of general information of patients between different K-F ring grading groups

指标	0级（n=5）	1级（n=18）	2级（n=24）	3级（n=16）	4级（n=44）	统计值	P值
年龄（岁）	37.60±12.44	29.39±7.70	33.50±7.66	32.25±8.85	31.45±10.28	F=1.019	0.401
病程（月）	12.0（5.5～240.0）	54.0（21.0～87.0）	42.5（24.0～72.0）	78.0（15.0～135.0）	36.0（12.0～81.0）	F=0.872	0.484
性别［例（%）］						χ²=5.268	0.261
男	2（40.0）	15（83.3）	13（54.1）	10（62.5）	26（59.0）
女	3（60.0）	3（16.6）	11（45.8）	6（37.5）	18（41.0）

下载: 导出CSV

表 2 不同K-F环分级组间HAMA评分比较

Table 2. Comparison of HAMA scores between different K-F ring grading groups

组别	例数	HAMA评分（分）
0级	5	4.800±1.304
1级	18	8.444±4.792
2级	24	12.630±3.019^1）
3级	16	17.560±3.577^1）2）3）
4级	44	15.910±6.730^1）2）
F值		16.340
P值		<0.001
注：与0级比较，1）P<0.05；与1级比较，2）P<0.05；与2级比较，3）P<0.05。

下载: 导出CSV

表 3 不同K-F环分级组间HAMD评分比较

Table 3. Comparison of HAMD scores between different K-F ring grading groups

组别	例数	HAMD评分（分）
0级	5	2.00（0.00～2.50）^1）
1级	18	3.00（1.75～6.00）^1）
2级	24	5.00（2.00～8.00）^1）
3级	16	5.50（2.25～17.75）^1）
4级	44	13.00（2.00～22.00）
F值		12.760
P值		<0.001
注：与4级比较，1）P<0.05。

下载: 导出CSV

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