视网膜中央动脉阻塞患者远期发生急性冠脉综合征的风险分析

Long-term risk of acute coronary syndrome in patients with central retinal artery oclusion

目的 探索分析视网膜中央动脉阻塞(CRAO)患者远期发生急性冠脉综合征(ACS)的风险。方法 本研究连续纳入2017年12月至2019年12月于武汉大学人民医院眼科首次诊断为CRAO且溶栓治疗成功的119例患者为CRAO组;用倾向性评分匹配(1∶1)控制主要混杂因素(性别、年龄、糖尿病、高血压、目前吸烟状态)的影响后连续纳入同时期在武汉大学人民医院就诊的体检人群作为对照组(n=119)。应用Kaplan-Meier生存分析比较两组患者的无ACS生存率差异;应用Cox回归分析探讨CRAO与远期发生ACS的关联;应用亚组分析以显示各个因素(年龄、性别、糖尿病、高血压)在CRAO与ACS远期发生风险的关联中的作用。结果 本研究平均随访时间为(28.11±6.03)个月。Kaplan-Meier生存分析显示,CRAO患者的无ACS生存率显著较低;Cox回归分析表明,CRAO(HR=2.521,95%CI:1.014~6.262)、年龄(HR=1.072,95%CI:1.027~1.119)、目前吸烟(HR=3.338,95%CI:1.404~7.937)与糖尿病(HR=2.584,95%CI:1.061~6.294)均是ACS发生的独立危险因素(P<0.05)。亚组分析的结果显示,在60岁及以上的人群中,CRAO仍对ACS发生风险有着显著影响(HR=2.721,95%CI:1.055~7.015,P<0.05)。结论 CRAO患者远期发生ACS的风险升高,该风险尤其在60岁以上人群中更为显著,应加强对老年CRAO患者的冠心病筛查。

Objective To analyze the long-term risk of acute coronary syndrome(ACS)in patients with central retinal artery occlusion(CRAO).Methods Patients firstly diagnosed with CRAO and successfully treated with thrombolytic therapy at Department of Ophthalmology in Renmin Hospital of Wuhan University from Dec.2017 to Dec.2019 were chosen into CRAO group(n=119),The healthy persons from Renmin hospital of Wuhan University were consecutively chosen into control group(n=119)through propensity score matching(1:1)to control the influence of major confounding factors(sex,age,diabetes,hypertension and currently smoking status)in the same period.Kaplan-Meier analysis was used to compare the ACS-free survival rates of the two groups.The correlation between CRAO and long-term risk of ACS was discussed by using Cox regression analysis.Subgroup analysis was applied to show the roles of various factors(age,sex,diabetes and hypertension)in the association between CRAO and the long-term risk of ACS.Results The average follow-up time was 28.11±6.03 months in this study.Kaplan-Meier survival analysis showed that ACS-free survival rates was significantly lower in CRAO patients.The results of Cox regression analysis showed that CRA0(HR=2.521,95%CI:1.014~6.262),age(HR=1.072,95%CI:1.027~1.119),currently smoking(HR=3.338,95%CI:1.404~7.937)and diabetes(HR=2.584,95%CI:1.061~6.294)were independent risk factors for ACS occurrence(all P<0.05).The results of subgroup analysis showed that in population aged over 60,CRAO stll has a significant impact on the risk of ACS(HR=2.721,95%CI:1.055~7.015,P<0.05).Conclusions The long-term risk of ACS increases in CRAO patients,especially in those aged over 60,so the screening for coronary heart disease should be enhanced in elderly patients with CRAO.