Hubbard法评价视网膜血管改变与高血压冠状动脉狭窄的相关性

Retinal vessels evaluated by Hubbard methods and their association with coronary artery stenosis in hypertensive patients

目的 探讨Hubbard法评价高血压患者视网膜血管改变与64层螺旋CT冠状动脉造影诊断冠状动脉狭窄的相关性。方法选取行双源64层螺旋CT冠状动脉造影检查的110例高血压患者，对其进行眼底照相，并采用Hubbard法对视网膜血管进行详细评价，测定视网膜动脉狭窄程度、动静脉交叉压迫征严重程度和视网膜动静脉直径比值。结果73例（66．4％）高血压患者被诊断为冠状动脉狭窄。冠状动脉狭窄组的视网膜动脉狭窄程度和动静脉交叉压迫征的严重度，均较对照组明显增加（P〈0.05）。冠状动脉狭窄患者，随着狭窄程度的增加，视网膜动脉狭窄程度、动静脉交叉压迫征的严重度均明显增加（P〈0．05）。冠状动脉狭窄者视网膜动脉直径和动静脉直径比值均明显小于对照组（P〈0．05），而视网膜静脉直径并无明显变化（P〉0．05）。另外，冠状动脉狭窄患者，随着狭窄程度的增加，视网膜动脉直径与视网膜动静脉比值均明显缩小（P〈0．05）。视网膜动脉狭窄对冠状动脉狭窄程度的阳性预测率为76．62％，灵敏度为80．82％；视网膜动静脉交叉压迫征的阳性预测值为89．74％，特异性为89．19％。结论采用Hubbard法评价高血压患者视网膜血管的改变，可以很好地间接反映冠状动脉的狭窄程度。该视网膜血管评价方法，可以用于高血压患者的冠心病普查，并为进一步施行64层螺旋CT冠状动脉造影检查提供依据。

Objective TO investigate the retinal micro-vascular status evaluated by Hubbard method and their association with coronary artery stenosis （CAS） in hypertensive patients. Methods Fundus images were taken in 110 hypertension patients without diabetes undergoing 64-slice CT coronary artery angiography. The change of hypertensive retinopathy including focal retinal arteriolar narrowing, arteriovenous nicking, and arteriob-to-venular ratio （AVR） was analyzed by Hubbard method. Results CAS were detected by coronary angiography in 73 patients （66.4%）. The mean values of retinal arteriole diameter and AVR in CAS group were lower than that in controls （P〈0.05）. There was no difference in the diameter of retinal venule between CAS and control groups （P〉0.05）. The degree of focal retinal arteriolar narrowing and arteriovenous nicking in CAS group was significantly higher than that in controls （P〈0.05）. When the degree of CAS increased in different subsets of CAS group, the grades of focal retinal arteriolar narrowing and arteriovenous nicking were also elevated, and the values of AVR were decreased. The positive predictive value and sensitivity of focal retinal arteriolar narrowing for CAS was 76.62% and 80.82%, respectively. In addition, the positive predictive value and specificity of arteriovenous nicking for CAS was 89.74% and 89.19%, respectively. Conclusion The change of hypertension retinopathy evaluated by Hubbard method may effectively reflect the degree of CAS in hypertension patients, which indicate that the methods would be useful in coronary heart disease screen before performing 64-slice CT coronary artery angiography.