中国神经再生研究(英文版) ›› 2024, Vol. 19 ›› Issue (5): 1156-1160.doi: 10.4103/1673-5374.382863

• 原著:视神经损伤修复保护与再生 • 上一篇    

视网膜微血管状况对复发性脑血管事件有预后价值:一些前瞻性观察研究

  

  • 出版日期:2024-05-15 发布日期:2023-11-01

Increased retinal venule diameter as a prognostic indicator for recurrent cerebrovascular events: a prospective observational study#br#

Ying Zhao1, 2, Dawei Dong1, 2, Ding Yan1, 2, Bing Yang1, 2, Weirong Gui1, 2, Man Ke1, 2, Anding Xu1, 2, *, Zefeng Tan3, *   

  1. 1Department of Neurology and Stroke Center, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; 2Clinical Neuroscience Institute, the First Affiliated Hospital of Jinan University, Guangzhou, Guangdong Province, China; 3Department of Neurology, the First People’s Hospital of Foshan, Foshan, Guangdong Province, China
  • Online:2024-05-15 Published:2023-11-01
  • Contact: Zefeng Tan, PhD, tanzaister@gmail.com; Anding Xu, PhD, tlil@jnu.edu.cn.
  • Supported by:
    This study was supported by the Youth Fund of Fundamental Research Fund for the Central Universities of Jinan University, No. 11622303 (to YZ).

摘要:

作者既往研究发现,视网膜静脉增宽与缺血性脑卒中动脉粥样硬化血栓形成亚型相关,但是对于视网膜血管改变在缺血性脑卒中患者脑血管事件复发的预测价值尚无定论。为了解急性缺血性脑卒中患者的视网膜血管系统参数与脑血管事件之间的关系,此次前瞻性观察性研究在2015年10月至2017年3月在暨南大学第一医院招募了141例急性缺血性脑卒中患者,在入院72h内接受数字视网膜成像观察,并随访了3年。结果发现,在校正相关危险因素后,距离视盘0.5-1.0 DD范围内平均动脉直径大于74.14μm的患者和距离视盘0.5-1.0 DD范围内平均静脉直径大于83.91μm的患者更容易出现脑血管事件的复发。进而建立了3种多元Cox比例风险回归模型,模型一为传统危险因素,模型二在模型一的基础上结合了距离视盘0.5-1.0 DD范围内平均动脉直径,模型三在模型一的基础上结合了距离视盘0.5-1.0 DD范围内平均静脉直径。这3种模型中,模型三预测复发性脑血管事件的能力最好,其次是模型二和模型一。这提示在传统危险因素的基础上结合视网膜血管口径将提高预测复发性脑血管事件的能力,且数字视网膜成像可作为一种有用且无创的检查方法用于识别需要更加密切监测和积极管理的高危脑血管事件复发的患者。

https://orcid.org/0000-0001-8284-612X (Zefeng Tan); https://orcid.org/0000-0003-3154-0985 (Anding Xu)

关键词: 视网膜, 微血管, 数字视网膜成像, 急性缺血性脑卒中, 复发, 脑血管事件, 小静脉, 动脉, 直径, 预测

Abstract: Microvasculature of the retina is considered an alternative marker of cerebral vascular risk in healthy populations. However, the ability of retinal vasculature changes, specifically focusing on retinal vessel diameter, to predict the recurrence of cerebrovascular events in patients with ischemic stroke has not been determined comprehensively. While previous studies have shown a link between retinal vessel diameter and recurrent cerebrovascular events, they have not incorporated this information into a predictive model. Therefore, this study aimed to investigate the relationship between retinal vessel diameter and subsequent cerebrovascular events in patients with acute ischemic stroke. Additionally, we sought to establish a predictive model by combining retinal veessel diameter with traditional risk factors. We performed a prospective observational study of 141 patients with acute ischemic stroke who were admitted to the First Affiliated Hospital of Jinan University. All of these patients underwent digital retinal imaging within 72 hours of admission and were followed up for 3 years. We found that, after adjusting for related risk factors, patients with acute ischemic stroke with mean arteriolar diameter within 0.5–1.0 disc diameters of the disc margin (MAD0.5–1.0DD) of ≥ 74.14 μm and mean venular diameter within 0.5–1.0 disc diameters of the disc margin (MVD0.5–1.0DD) of ≥ 83.91 μm tended to experience recurrent cerebrovascular events. We established three multivariate Cox proportional hazard regression models: model 1 included traditional risk factors, model 2 added MAD0.5–1.0DD to model 1, and model 3 added MVD0.5–1.0DD to model 1. Model 3 had the greatest potential to predict subsequent cerebrovascular events, followed by model 2, and finally model 1. These findings indicate that combining retinal venular or arteriolar diameter with traditional risk factors could improve the prediction of recurrent cerebrovascular events in patients with acute ischemic stroke, and that retinal imaging could be a useful and non-invasive method for identifying high-risk patients who require closer monitoring and more aggressive management.

Key words: acute ischemic stroke, arteriolar, cerebrovascular events, diameter, digital retinal imaging, microvasculature, prediction, recurrent, retina, venular