老年人眼底微血管病变与急性冠脉事件的相关性研究：基于社区的1743例病例对照分析

Correlation between senile retinal microvascular disease and acute coronary event in the old：a controlled study of 1 509 cases in communities

目的：探讨老年人眼底微血管病变与急性冠脉事件（ACE）的相关性。方法采用基于社区的病例对照方法，选择山东省济宁市兴隆庄煤矿社区1743例年龄≥60岁的居民进行问卷调查、体格检查和实验室检查。选取符合ACE诊断标准的139例患者作为观察组，1509例确定未患ACE作为对照组。采集两组性别、年龄、吸烟、饮酒、高血压、糖尿病、文化程度、体育锻炼、眼底微血管病变、空腹血糖、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、三酰甘油（TG）、收缩压、舒张压、体质量指数（BMI）进行单因素分析，将有统计学意义的危险因素进行多因素非条件logistic回归分析，筛选出影响ACE发生的独立危险因素。结果单因素分析显示，ACE发生的危险因素包括年龄、性别、吸烟、高血压、糖尿病、LDL-C、收缩压、舒张压、BMI、眼底微血管病变（P＜0.05或P＜0.01）。在眼底微血管病变中，观察组动静脉交叉征〔44.6%（62/139）比27.8%（419/1509）〕、硬性渗出〔9.4%（13/139）比4.9%（74/1509）〕、棉絮斑〔19.4%（27/139）比7.3%（110/1509）〕发生率明显高于对照组（P＜0.05或P＜0.01）。Logistic回归分析显示，年龄〔P＝0.002，优势比（OR）＝1.06，95%可信区间（95%CI）＝1.04∽1.09〕、吸烟（P＝0.032，OR＝2.17，95%CI＝2.04∽2.30）、眼底微血管病变（P＝0.010，OR＝2.33，95%CI＝0.97∽1.27）、高血压（P＜0.001，OR＝5.21，95%CI＝4.11∽6.36）、糖尿病（P＝0.021， OR＝1.03，95%CI＝1.01∽1.05）及LDL-C（P＝0.020，OR＝2.80，95%CI＝2.65∽2.99）是发生ACE的独立危险因素。结论眼底微血管病变是发生ACE的独立危险因素，眼底血管照相检查可以作为预测ACE的检查方法。

Objective To study the relationships between retinal microvascular disease and acute coronary event （ACE） among aged people. Methods A controlled study for senile people in communities was conducted. Xinglong Zhuang Coal Mine Community in Jining city, Shandong province was chosen to carry out the study, and the residents in that area aged≥60 years were asked to take questionnaire survey, physical and laboratory examinations. There were 139 cases met the diagnostic criteria of ACE being in the observation group, and 1 509 cases without ACE were assigned in the control group. The gender, age, smoking, alcohol intake, hypertension, diabetes mellitus, education, physical exercise, retinal microvascular disease, fasting blood-glucose, high density lipoprotein cholesterin （HDL-C）, low density lipoprotein cholesterin （LDL-C）, triacylglycerol （TG）, systolic pressure, diastolic pressure, body mass index （BMI） were collected in the two groups to perform univariate analysis. Multivariate non-conditional logistic regression analysis was used for the factors with statistical significance to screen out the independent risk factors that could affect the occurrence of ACE. Results The univariate analysis showed：the risk factors that might cause the occurrence of ACE included age, gender, smoking, hypertension, diabetes mellitus, LDL-C, systolic pressure, diastolic pressure, BMI, and retinal microvascular disease （P〈0.05 or P〈0.01）. In the ACE patients of observation group, the rates of presence of arteriovenous crossing sign [44.6%（62/139） vs. 27.8%（419/1 509）], hard exudates [9.4%（13/139） vs. 4.9%（74/1 509）] and cotton-wool patches [19.4%（27/139） vs. 7.3%（110/1 509）] in retinal microvascular disease were significantly higher than those in control group （P〈0.05 or P〈0.01）. The logistic regression analysis showed：age [P=0.002, odds ratio （OR）=1.06, 95%confidence interval （95%CI）=1.04-1.09], smoking （P=0.032, OR=2.17, 95%CI=2.04-2.30）, retinal microvascular disease （P = 0.010, OR = 2.33, 95%CI = 0.97 - 1.27）, hypertension （P 〈 0.001, OR = 5.21, 95%CI=4.11-6.36）, diabetes mellitus （P=0.021, OR=1.03, 95%CI=1.01-1.05） and LDL-C （P=0.020, OR=2.80, 95%CI = 2.65 - 2.99） were the independent risk factors for the occurrence of ACE. Conclusions Retinal microvascular disease is the independent risk factor for the occurrence of ACE. The retinal angiography can be a useful examination to forecast ACE.