眼底指标改变与脑卒中患病的相关性

【摘要】 目的  探讨眼底指标改变与脑卒中患病风险的相关性。设计  病例对照研究。研究对象  北京同仁医院、北京天坛医院年龄（63.6±10.2）岁的脑卒中患者450例，对照组为年龄（62.5±8.7）岁“北京眼病研究”非脑卒中受检者566例。方法  所有受试者单张45度眼底数码照相。两位眼科医师盲法评价眼底指标改变。应用Logistic 回归分析眼底指标与脑卒中患病的相关性及脑卒中发病风险性，应用Orange 2 软件统计图对分析结果进行可视化。主要指标  视网膜神经纤维层缺损（RNFLD）、视网膜动脉缩窄、动静脉交叉压迫征、视网膜静脉迂曲扩张、视盘改变、黄斑病变的构成比及与脑卒中患病的OR值。结果 非脑卒中组、脑卒中组视网膜动脉管径缩窄出现率分别为46.3%、65.1%（P<0.05），视网膜静脉扩张出现率分别为12.5%、38.0%（P<0.05），RNFLD出现率分别为12.7%、38.0%（P<0.05），视网膜棉絮斑出现率分别为1.6%、4.4%（P<0.05），视网膜出血出现率分别为4.6%、11.3%（P<0.05），视盘病变出现率分别为7.1%、16.9%（P<0.05），黄斑病变出现率分别为6.4%、13.1%（P<0.05）。Logistic 回归分析显示，RNFLD（OR=4.163, 95%CI 2.792-6.208）和视网膜静脉扩张（OR=3.443, 95%CI 2.333-5.082）与脑卒中患病高度相关。除性别对于脑卒中患病有负向影响（男性更易罹患脑卒中）外，RNLFD、视网膜静脉扩张、黄斑病变对脑卒中患病有正向影响。在眼底组合指标中，视网膜动脉缩窄、静脉扩张、RNFLD同时存在与脑卒中患病相关性最大。结论  眼底RNLFD、视网膜动脉缩窄、静脉扩张三项指标联合对脑卒中发病预警有重要提示作用，眼底血管变化与RNFLD改变可为脑血管病变的筛查提供简易方法。（眼科， 2015， 24： 13-18）

The study on the correlation between fundus changes and the risk of cerebral stroke

【Abstract】 Objective To explore the correlation between fundus changes and the risk of cerebral stroke. Design Case-control study. Participants  450 patients with cerebral stroke, derived from Beijing Tongren Hospital and Beijing Tiantan Hospital, with mean age of（63.6±10.2） years old. 566 subjects without stroke were selected from Beijing Eye Study, with mean age of(62.5±8.7) years old. Methods All subjects had undertaken 45-degree fundus photography. Two ophthalmologists evaluated those fundus photographs to find out the changes of fundus indicators. Logistic regression was used to analyze the correlation between fundus changes and stroke. Orange 2 analysis software was used to visualize the data results. Main Outcome Measures The component ratio of retinal nerve fiber layer defect (RNFLD), retinal arterial narrowing, arteriovenous nicking, vein dilatation, retinopathy (cotton wool spot, and retinal hemorrhage), optic nerve changes and macular diseases and OR value of correlating to stroke. Results  The percentage of retinal arterial narrowing was 46.3% in non-stroke group and 65.1% in stroke group (P<0.05). The percentage of retinal vein dilation was 12.5% in non-stroke group and 38.0% in stroke group (P<0.05). The percentage of RNFLD was 12.7% in non-stroke group and 38.0% in stroke group (P<0.05). The percentage of retinal cotton wool spot was 1.6% in non-stroke group and 4.4% in stroke group (P<0.05). The percentage of retinal hemorrhage was 4.6% in non-stroke group and 11.3% in stroke group (P<0.05). The percentage of optic disc changes was 7.1% in non-stroke group and 16.9% in stroke group (P<0.05). The percent age of macular diseases was 6.4% in non-stroke group and 13.1% in stroke group (P<0.05). Logistic regression analysis showed that RNFLD (OR=4.163, 95%CI 2.792-6.208) and retinal vein dilatation (OR=3.443, 95%CI 2.333-5.082) highly correlated with stroke significantly. Gender had negative correlation with stroke (males were more susceptible to stroke than females). RNFLD and retinal vein dilatation, macular diseases had positive correlation with stroke. Fundus indicators of retinal arterial narrowing, vein dilatation and RNFLD coexisting are most correlated with high risk of stroke. Conclusions Coexisting of RNFLD, retinal arterial narrowing and vein dilatation highly correlate to cerebral stroke.  Evaluation of the retinal circulation and nerve fiber layer defect in vivo maybe offer a simple method to screening cerebrovascular diseases. (Ophthalmol CHN, 2015, 24: 13-18)