视网膜血管直径和分叉角度与患者缺血性脑卒中的相关性

Association of retinal vessel diameter and bifurcation angle with ischemic stroke

目的探讨视网膜血管直径和分叉角度与患者缺血性脑卒中的相关性。方法选取2019年1月至2020年6月在新乡医学院第一附属医院确诊为缺血性脑卒中的住院患者208例(413眼)为卒中组,以同期同年龄段未患有脑卒中者64例(128眼)为对照组。通过问卷调查和实验室检查获得患者的一般情况、吸烟和饮酒史以及血压、血脂情况;以视盘为中心,距离为视盘边缘1.5个视盘直径(DD)拍摄受试者双眼眼底照片,使用半自动软件IVAN对眼底血管进行测量并计算视网膜中央动脉直径(CRAE)和视网膜中央静脉直径(CRVE)以及视网膜动静脉直径比值(AVR);使用软件Photoshop 8.0对视网膜血管(颞上、下动脉及其伴行静脉)的第一级分叉角度进行测量。比较两组受试者的CRAE、CRVE、AVR及视网膜血管分叉角度的差异及其与缺血性脑卒中的相关性。结果卒中组患者的CRAE、CRVE(141.24±16.01)μm、(225.67±20.73)μm较对照组(155.06±13.37)μm、(220.53±15.93)μm分别呈现出显著的缩窄和扩张,差异均有统计学意义(均为P<0.05),伴随卒中组患者AVR(0.63±0.08)较对照组(0.71±0.07)显著下降,差异有统计学意义(P<0.05)。卒中组患者视网膜颞上动、静脉和颞下动、静脉的分叉角度(84.65°±20.00°、81.10°±18.81°、88.45°±17.84°、86.96°±16.87°)均显著大于对照组(73.70°±19.49°、69.68°±17.47°、76.42°±16.05°、79.02°±16.38°),差异均有统计学意义(均为P<0.001)。logistic多因素回归分析显示,控制性别、年龄、高血压病史、吸烟史、饮酒史等因素影响后,CRVE的增大以及视网膜颞上动、静脉和颞下动、静脉的分叉角度增大与缺血性脑卒中的发生均显著相关(均为P<0.05);CRAE的减小与缺血性脑卒中的发生显著相关(P<0.05)。结论视网膜血管异常与缺血性脑卒中的发生具有相关性,CRAE减小、CRVE增大、视网膜血管分叉角度增大是发生缺血性脑卒中的危险因素,对缺血性脑卒中的发生可能具有一定预测价值。

Objective To investigate the association of retinal vessel diameter and bifurcation angle with ischemic stroke.Methods A total of 208 patients(413 eyes)with ischemic stroke admitted to the First Affiliated Hospital of Xinxiang Medical University from January 2019 to June 2020 were selected in the stroke group,and 64 patients(128 eyes)of the same age without stroke in the control group.Their general situation,smoking and drinking history,blood pressure,and serum lipids were obtained through questionnaire surveys and laboratory examinations.The fundus photos were taken with the optic disc as the center at a distance of 1.5 disc diameters(DD)from the edge of the optic disc.The central retinal artery equivalent(CRAE),central retinal vein equivalent(CRVE),and arteriovenous ratio(AVR)were measured using IVAN,a semi-automatic software.The primary bifurcation angles of retinal vessels(superior temporal artery,inferior temporal artery,and their accompanying veins)were measured by Photoshop 8.0.Following the comparison of CRAE,CRVE,AVR,and bifurcation angles of retinal vessels between the two groups,their associations with ischemic stroke were analyzed.Results CRAE and CRVE(141.24±16.01)μm and(225.67±20.73)μm in the stroke group were reduced and increased respectively compared with the control group(155.06±13.37)μm and(220.53±15.93)μm(both P<0.05).AVR(0.63±0.08)in the stroke group was significantly lower than that(0.71±0.07)in the control group(P<0.05).The bifurcation angles of superior temporal artery and vein(84.65°±20.00°and 81.10°±18.81°)and inferior temporal artery and vein(88.45°±17.84°and 86.96°±16.87°)in the stroke group were significantly higher than those(73.70°±19.49°and 69.68°±17.47°;76.42°±16.05°and 79.02°±16.38°)in the control group(all P<0.001).Logistic regression analysis results showed that after excluding gender,age,history of hypertension,smoking history,and drinking history,increases in CRVE and bifurcation angles of superior and inferior temporal arteries and veins,and decreases in CRAE were significantly associated with the occurrence of ischemic stroke(all P<0.05).Conclusion Retinal vascular abnormalities are associated with ischemic stroke.Decreases in CRAE and increases in CRVE and bifurcation angles of retinal vessels are risk factors contributing to ischemic stroke,which may help predict the development of ischemic stroke.