原发性高血压病的眼底病变

The changes in ocular fundus in the essential hypertension

原发性高血压眼底病变是一种常见的与血压升高密切相关的眼部体征,分为视网膜血管病变和视网膜血管以外病变。视网膜血管病变包括动脉痉挛、动脉硬化、动静脉交叉处的Salus征、Gunn现象等;视网膜血管外病变包括视网膜水肿混浊、出血、硬性渗出、棉绒状斑,脉络膜Elschnig斑、Segrist条纹及视乳头水肿等。视网膜动脉硬化发生在动脉痉挛持续一段时间之后,见于缓进型高血压第二、三期。视网膜血管以外病变,由动脉的强烈痉挛引起,见于高血压急进型或缓进型病情突然恶化之际。发生视网膜血管以外病变,提示心、肾、脑等全身重要器官已有严重的器质性损害和功能衰竭。特别是视乳头水肿一旦出现,则提示患者生命预后极为严峻。

Hypertensive ocular fundus changes are the common characterized by a spectrum of retinal vascular signs in people with elevated blood pressure. There are two evidences including vascular signs and retinal signs. Retinal vascular signs are vasoconstriction, narrowing of the retinal arterioles and arteriovenous nicking. Retinopathy is one of several markers of target-organ damage in hypertension, reflects the excudative stage such as retinal hemorrhage, microaneurysm, hard exudates and cotton wool spots. The hypertensive choroidopathy includes Elschnig＇s spots and Segrist＇s streaks. Hypertensive neuropathy appears in patient with severe hypertension. It is well known that the retinal circulation shares anatomical, physiological, and embryologic features with the cerebral circulation. Signs of hypertensive retinopathy are common and are correlated with elevated blood pressure. Recent studies show that some of these signs （e.g., retinal hemorrhages, microaneurysms, and cotton-wool spots） predict stroke and death from stroke independently of elevated blood pressure and other risk factors. Patients with these signs of retinopathy may benefit from close monitoring of cerebrovascular risk and intensive measures to reduce that risk.