视网膜血管形态学特征与急性轻症脑卒中患者脑侧支循环和预后的相关性研究

The correlation between morphological characteristics of retinal blood vessels and cerebral collateral circulation and prognosis in patients with acute minor stroke

目的:分析视网膜血管形态特征与软脑膜侧支循环功能的相关性,探索急性缺血性卒中患者侧支循环功能及预后的预测模型。方法:纳入53例急性缺血性卒中患者,利用头颈部CT血管造影(CT angiography,CTA)检查评估侧支循环评分,分为良好侧支组及不良侧支组;以90天改良Rankin评分作为预后指标。分析眼底彩色照片,提取视网膜血管形态参数,包括:视网膜各象限的动、静脉血管主干、分支管径、弯曲度、均衡度、血管树分型维数、视杯及视盘几何尺寸等。组间差异显著的参数,与侧支循环评分、卒中预后评分进行相关性分析,并建立回归模型进一步验证。结果:本研究纳入的病例中,良好侧支组的良好预后率显著高于不良侧支组。视网膜血管形态参数中,中央视网膜动脉当量[(43.29±5.02)vs(39.05±4.21),P=0.002)]和动脉平均管径[(51.49(5.35)vs(49.07±4.29),P=0.040]在组间差异显著。其余参数无显著差异。中央视网膜动脉当量和动脉平均管径与软脑膜侧支循环评分显著相关,相关系数分别为0.418(P=0.002)和0.290(P=0.035),其余参数无显著相关性。对侧支循环评分进行Logistic回归提示,CRAE与侧支评分相关(OR=1.349,95%CI 1.101~1.653,P=0.004),CRAE预测侧支循环评分的ROC曲线下面积为0.747(95%CI 0.615~0.879,P=0.002);动脉平均管径在侧支循环评分的回归分析中不具有统计学意义(OR=1.086,95%CI 0.976~1.209,P=0.129)。各视网膜血管参数在90天改良Rankin评分的Logistic回归中均无统计学意义。结论:在轻型卒中患者中,中央视网膜动脉当量与软脑膜侧支循环功能显著相关,可反映软脑膜侧支循环功能状态。本研究检验的视网膜血管形态参数均不能预测缺血性脑卒中预后。

Objective To analyze the correlation between the morphological characteristics of retinal blood vessels and the collateral circulation function of the pia mater,and to explore a predictive model for collateral circulation function and prognosis in patients with acute ischemic stroke.Method 53 patients with acute ischemic stroke were included and evaluated for collateral circulation score using head and neck CTA examination.They were divided into good collateral group and bad collateral group;Using the 90 day modified Rankin score as a prognostic indicator.Analyze fundus color photographs and extract morphological parameters of retinal blood vessels,including the main and branch diameters of retinal arteries and veins in each quadrant,curvature,balance,vascular tree classification dimension,geometric dimensions of the optic cup and disc,etc.Analyze the correlation between parameters with significant inter group differences,collateral circulation score,and stroke prognosis score,and establish a regression model for further validation.Result Among the cases included in this study,the good prognosis rate of the good collateral group was significantly higher than that of the bad collateral group.Among the morphological parameters of retinal blood vessels,the central retinal artery equivalent[(43.29±5.02)vs(39.05±4.21),P=0.002]and average arterial diameter[(51.49±5.35)vs(49.07±4.29),P=0.040]showed significant differences between groups.There was no significant difference in the other parameters.The central retinal artery equivalent and average arterial diameter were significantly correlated with the pia mater collateral circulation score,with correlation coefficients of 0.418(P=0.002)and 0.290(P=0.035),respectively.There was no significant correlation between other parameters.The logistic regression analysis of collateral circulation score showed that CRAE was correlated with collateral circulation score(OR=1.349,95%CI 1.101-1.653,P=0.004),and the area under the ROC curve predicted by CRAE was 0.747(95%CI 0.615-0.879,P=0.002);The mean arterial diameter was not statistically significant in the regression analysis of collateral circulation score(OR=1.086,95%CI 0.976~1.209,P=0.129).All retinal vascular parameters were not statistically significant in the 90 day modified Rankin score logistic regression.Conclusion In mild stroke patients,the central retinal artery equivalent is significantly correlated with the pia mater collateral circulation function,which can reflect the state of cerebral collateral circulation function.The morphological parameters of retinal blood vessels tested in this study cannot predict the prognosis of ischemic stroke.