Wang J J, Mitchell P, Rochtchina E, Tan A G, Wong T Y, Klein R
Centre for Vision Research, Department of Ophthalmology, University of Sydney, Westmead Hospital, Hawkesbury Road, Westmead, NSW 2145, Australia.
Br J Ophthalmol. 2004 Jan;88(1):104-9. doi: 10.1136/bjo.88.1.104.
To assess whether retinal arteriolar wall changes (focal narrowing and arteriovenous nicking) are associated with an increased 5 year risk of age related maculopathy (ARM).
The Blue Mountains Eye Study examined 3654 residents aged 49+ years living in a defined area, during 1992-4 (82.4% participation). After 5 years, 2335 surviving participants (75.1%) were re-examined during 1997-9. Retinal photographs were graded using the Wisconsin ARM grading system. Incident late (neovascular or atrophic) or early stage ARM was defined using a side by side grading method. Focal arteriolar narrowing (localised constricted arteriolar segments causing a sausage-like appearance), and arteriovenous (AV) nicking (constriction on both sides of the venule where crossed by an arteriole), were graded by comparison with standard photographs. All retinal vessels passing through a circumferential zone 0.5-1.0 disc diameters from the optic disc margin were measured from digitised images. Summarised estimates for central retinal arteriolar equivalent (CRAE) represent an average diameter of arterioles for that eye. Associations were assessed after adjusting for age, sex, smoking, mean arterial blood pressure, and other vascular risk factors.
Of 2314 baseline participants at risk of late stage ARM, either late stage lesion developed in 34 participants (1.5%). Of 2203 at risk of early stage ARM, this sign developed in 197 participants (8.9%). Focal arteriolar narrowing was present at baseline in at least one eye of 162 survivors (6.9%) and severe AV nicking was present in 187 people (8.1%). Over 5 years, 4.9% of subjects with and 1.2% of those without focal narrowing developed either late stage ARM lesion, age adjusted relative risk (RR) 2.3, 95% confidence interval (CI) 1.0 to 5.1, multivariate adjusted odds ratios (OR) 2.1 (95% CI 0.9 to 4.9). Similarly, 3.7% of subjects with and 1.3% of those without severe AV nicking developed late ARM lesions, age adjusted RR 2.1 (95% CI 0.9 to 5.1), multivariate adjusted OR 2.2 (95% CI 0.9 to 5.6). Corresponding age adjusted RR and multivariate adjusted OR for development of early stage ARM were 1.4 (95% CI 0.9 to 2.0) and 1.3 (95% CI 0.8 to 2.1) for focal arteriolar narrowing, and 1.6 (95% CI 1.0 to 2.3) and 1.8 (95% CI 1.1 to 2.9) for severe AV nicking, respectively. No associations between baseline CRAE and 5 year incident late or early stage ARM were found.
Although of borderline statistical significance, the consistent associations found in this study suggest that structural retinal arteriolar changes may either contribute to ARM progression or may share common pathological pathways with ARM.
评估视网膜小动脉壁改变（局灶性狭窄和动静脉交叉压迹）是否与年龄相关性黄斑病变（ARM）5年风险增加相关。
蓝山眼研究在1992 - 1994年期间对居住在特定区域的3654名49岁及以上居民进行了检查（参与率82.4%）。5年后，在1997 - 1999年期间对2335名存活参与者（75.1%）进行了重新检查。使用威斯康星ARM分级系统对视网膜照片进行分级。采用并排分级法定义新发晚期（新生血管性或萎缩性）或早期ARM。通过与标准照片比较，对局灶性小动脉狭窄（局部狭窄的小动脉段导致腊肠样外观）和动静脉（AV）交叉压迹（小静脉被小动脉交叉处两侧的狭窄）进行分级。从数字化图像中测量穿过距视盘边缘0.5 - 1.0个视盘直径的圆周区域的所有视网膜血管。视网膜中央动脉等效值（CRAE）的汇总估计值代表该眼小动脉的平均直径。在对年龄、性别、吸烟、平均动脉血压和其他血管危险因素进行调整后评估相关性。
在2314名有晚期ARM风险的基线参与者中，34名参与者（1.5%）出现了晚期病变。在2203名有早期ARM风险的参与者中，197名参与者（8.9%）出现了该体征。162名幸存者（6.9%）至少一只眼睛在基线时存在局灶性小动脉狭窄，187人（8.1%）存在严重AV交叉压迹。在5年期间，有局灶性狭窄的受试者中有4.9%出现了晚期ARM病变，无局灶性狭窄的受试者中有1.2%出现，年龄调整相对风险（RR）为2.3，95%置信区间（CI）为1.0至5.1，多变量调整优势比（OR）为2.1（95%CI为0.9至4.9）。同样，有严重AV交叉压迹的受试者中有3.7%出现了晚期ARM病变，无严重AV交叉压迹的受试者中有1.3%出现，年龄调整RR为2.1（95%CI为0.9至5.1），多变量调整OR为2.2（95%CI为0.9至5.6）。局灶性小动脉狭窄导致早期ARM发生的相应年龄调整RR和多变量调整OR分别为1.4（95%CI为0.9至2.0）和1.3（95%CI为0.8至2.1），严重AV交叉压迹导致早期ARM发生的相应年龄调整RR和多变量调整OR分别为1.6（95%CI为1.0至2.3）和1.8（95%CI为1.1至2.9）。未发现基线CRAE与5年新发晚期或早期ARM之间存在关联。
尽管具有边缘统计学意义，但本研究中发现的一致关联表明，视网膜小动脉结构改变可能要么促成ARM进展，要么与ARM共享共同的病理途径。
