视网膜分支静脉阻塞视网膜微血管改变的定量研究

Retinal microvascular changes for branch retinal vein occlusion

目的研究视网膜分支静脉阻塞（BRVO）患者视网膜微血管改变的特点。设计病例对照研究。研究对象河北省邯郸市眼科医院连续的BRVO患者58例,对照组为＂邯郸眼病研究＂中按匹配原则抽取的非BRVO者200例。方法对被研究者的眼底彩色照片定性判读视网膜微血管局部改变;利用计算机辅助软件（IVAN software,Australia）定量测量视网膜微血管管径,比较两组间的差异。主要指标视网膜微血管局部改变包括局部视网膜动脉缩窄（FAN）、视网膜动静脉交叉压迫征（AVN）和动脉反光增强（OPAC）。定量测量指标为视网膜中央动脉直径（CRAE）、视网膜中央静脉直径（CRVE）和视网膜动静脉比值（AVR）。结果CRAE、CRVE、AVR在BRVO组和非BRVO组分别为（136.0±20.7）μm Vs.（152.0±19.3）μm（P=0.000）;（207.2±23.1）μm Vs.（235.3±29.7）μm（P=0.000）;（0.66±0.13）Vs.（0.65±0.06）（P=0.019）。经多因素校正后视网膜血管局部改变FAN、AVN和OPAC在两组间比较的相对危险度分别为5.65（95%CI=1.77-18.03）、3.42（95%CI=1.48-7.89）和3.44（95%CI=1.44-8.24）（P均〈0.05）。结论视网膜动、静脉直径在BRVO者比非BRVO者均变窄,视网膜血管的局部改变在BRVO者比非BRVO者显著,因此视网膜血管的定量、定性分析可作为BRVO的观察指标。

Objective To investigate the association between retinal microvascular abnormalities and branch retinal vein occlusion （BRVO）. Design Case-controlled study. Participants 58 cases of BRVO in Handan Eye Hospital and 200 control cases of non-BRVO with age-and gender-matched normal eyes from the population based Handan Eye Study. Methods Fundus ditated photographs for both eyes were obtained in all subjects. Signs of focal microvascular abnormalities were qualitatively evaluated from photographs. Retinal vascular caliber measurements were performed using IVAN software, Australia. Main Outcome Measures Focal arteriolar narrowing （FAN）, arteriovenous nicking （AVN）, opacification of arteriolar wall （OPAC）, central retinal arteriolar equivalent （CRAE）, central retinal venular equivalent （CRVE） and arteriole-to-venule ratio （AVR）. Results Among all BRVO patients, the mean CRAE was 136.0±20.7μm, and the mean CRVE was 207.2±23.1 μm, and AVR was 0.66-0.13. The mean CRAE, CRVE and AVR of the control eyes were 152.0±19.3μm, 235.3±29.7 μm and 0.65＋0.06, respectively. After adjusting for age, gender, hypertension and diabetes, patients with BRVO were significantly more likely to have FAN, AVN and OPAC signs, with the adjusted odds ratios of 5.65 （95%CI=1.77-18.03）, 3.42 （95%CI=1.48-7.89） and 3.44 （95%CI=1.44-8.24） than non-BRVO subjects, respectively（All P〈0.05）. Conclusions Eyes with BRVO had narrow CRAE and CRVE when compared with age-and gender-matched normal eyes. Our findings demonstrate a strong relation between BRVO and retinal microvascular changes. （Ophthalmol CHN, 2012, 21： 239-243）