Lima Carmen S P, Rocha Eduardo M, Silva Nadia M, Sonatti Maria F, Costa Fernando F, Saad Sara T O
Department of Internal Medicine, Faculty of Medical Sciences, State University of Campinas, Campinas, São Paulo, Brazil.
Acta Ophthalmol Scand. 2006 Apr;84(2):234-41. doi: 10.1111/j.1600-0420.2005.00604.x.
The aim of this study was to clarify whether the clinical, laboratory and genetic aspects of sickle cell disease (SCD) influence the occurrence of vessel alterations in the conjunctiva and retina.
A total of 102 SCD patients underwent biomicroscopical and retinal examination, in addition to evaluations of haemoglobin (Hb) and haematocrit (Ht) levels, fetal haemoglobin (HbF) estimations, serum creatinine and albuminuria levels, glomerular filtration rate (GFR) values, phenotypes, beta-globin gene haplotypes and alpha-thalassaemia. The relationship between ocular vessel alterations and clinical, laboratory and genetic features were evaluated using chi-squared or Fisher tests and logistic regression analysis. In 13 patients on enalapril treatment, a second ophthalmological evaluation was performed after a 12-month period to evaluate the longitudinal effect of the drug on ocular vessels.
Conjunctival vessel alteration (CVA) was not influenced by age, gender, HbF estimation, serum creatinine and albuminuria levels, GFR values, beta-globin gene haplotypes or alpha-thalassaemia. However, increased frequencies of CVA were found in patients with Hb </= 9.0 g/dl, Ht </= 26.7% and sickle cell anaemia (SS) phenotype. Retinal vessel alteration (RVA) was identified only in patients aged 17 years or older. Enalapril did not demonstrate ocular vessel amelioration after 12-months of daily use.
The results indicate that lower Hb and Ht levels and SS phenotype are risk factors for CVA, and age over 17 years may be risk factors for RVA in SCD patients.
本研究旨在阐明镰状细胞病（SCD）的临床、实验室及遗传学方面是否会影响结膜和视网膜血管病变的发生。
102例SCD患者接受了生物显微镜和视网膜检查，此外还评估了血红蛋白（Hb）和血细胞比容（Ht）水平、胎儿血红蛋白（HbF）测定、血清肌酐和蛋白尿水平、肾小球滤过率（GFR）值、表型、β-珠蛋白基因单倍型及α-地中海贫血。采用卡方检验或Fisher检验以及逻辑回归分析评估眼部血管病变与临床、实验室及遗传学特征之间的关系。对13例接受依那普利治疗的患者在12个月后进行了第二次眼科评估，以评估该药物对眼部血管的纵向影响。
结膜血管病变（CVA）不受年龄、性别、HbF测定、血清肌酐和蛋白尿水平、GFR值、β-珠蛋白基因单倍型或α-地中海贫血的影响。然而，Hb≤9.0 g/dl、Ht≤26.7%以及镰状细胞贫血（SS）表型的患者中CVA的发生率增加。视网膜血管病变（RVA）仅在17岁及以上的患者中被发现。每日使用依那普利12个月后未显示出眼部血管改善。
结果表明，较低的Hb和Ht水平以及SS表型是SCD患者发生CVA的危险因素，而17岁以上的年龄可能是发生RVA的危险因素。
